=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043977721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH LEE ELIASON CNP, FNP-C, CWS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2021
-----------------------------------------------------
Last Update Date | 02/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 NM - 564
-----------------------------------------------------
City | GALLUP
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87301-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-522-3681
-----------------------------------------------------
Fax | 505-473-9552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2418 E HISTORIC HIGHWAY 66 # 292
-----------------------------------------------------
City | GALLUP
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87301-4767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-906-6581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN-CNP69689
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------