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General NPI Number Information
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NPI Number | 1356760011
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Entity Type | Individual
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Provider Name | CHARISSA SALLIE ELLIOTT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 1706 W AGENCY RD
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1667
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Country | US
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Telephone | 319-768-5858
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Fax | 319-752-4653
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Provider Business Mailing Address
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Address Line | 1706 W AGENCY RD
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1667
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Country | US
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Telephone | 319-768-5858
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Fax | 319-752-4653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A087662
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN144548
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number | RN144548
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License Number State | AZ
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