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General NPI Number Information
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NPI Number | 1699071100
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Entity Type | Individual
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Provider Name | ALICIA A ELLIOTT CNS
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Gender | Female
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1910 SAINT JOE CENTER RD STE 23
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City | FORT WAYNE
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State | IN
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Zip | 46825-5000
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Country | US
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Telephone | 260-414-4025
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Fax | 260-484-5664
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Provider Business Mailing Address
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Address Line | 1910 ST JOE CTR RD #23
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City | FORT WAYNE
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State | IN
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Zip | 46825-1701
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Country | US
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Telephone |
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Fax |
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 71003708A
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License Number State | IN
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