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General NPI Number Information
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NPI Number | 1407838998
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Entity Type | Individual
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Provider Name | MARY PATRICE ELMORE RNC, WHNP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 808 JOLIET AVE UNIT 110
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City | LUBBOCK
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State | TX
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Zip | 79415-1148
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Country | US
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Telephone | 68-761-0545
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Fax | 806-761-0546
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Provider Business Mailing Address
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Address Line | 5219 CITY BANK PKWY SUITE 135
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City | LUBBOCK
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State | TX
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Zip | 79407-3544
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Country | US
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Telephone | 806-761-0333
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Fax | 806-722-2908
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP110878
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License Number State | TX
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