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General NPI Number Information
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NPI Number | 1033814959
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Entity Type | Organization
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Legal Business Name | ELITE RENEWCARE, LLC
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 4111E ROSE LAKE DR # 4827
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City | CHARLOTTE
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State | NC
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Zip | 28217-2858
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Country | US
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Telephone | 315-489-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 305 DERBY LN
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City | HOPE MILLS
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State | NC
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Zip | 28348-7556
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Country | US
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Telephone | 315-489-5440
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ANA ROSELIA SANTOS-BURKS
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Credential | NP-BC
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Telephone | 315-489-5440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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