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General NPI Number Information
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NPI Number | 1831636687
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Entity Type | Individual
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Provider Name | NANCY ELLIOTT
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Gender | Female
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 8300 CONSTITUTION NE ROOM 1303
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City | ALBUQUERQUE
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State | NM
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Zip | 87110
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Country | US
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Telephone | 505-559-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 VALDEZ DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-4857
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Country | US
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Telephone | 505-323-1726
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R56893
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License Number State | NM
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