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General NPI Number Information
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NPI Number | 1700401163
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Entity Type | Individual
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Provider Name | CAROLINE ETOK ELAD NP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2051 E MARY ST
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City | GARDEN CITY
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State | KS
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Zip | 67846-3617
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Country | US
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Telephone | 620-275-3777
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Fax | 620-275-3074
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Provider Business Mailing Address
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Address Line | 2051 E MARY ST
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City | GARDEN CITY
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State | KS
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Zip | 67846-3617
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Country | US
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Telephone | 620-275-3777
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Fax | 620-275-3074
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 79421
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5379421111
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License Number State | KS
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