MEDICARE: MRS. ANGELA MICHELLE ELAM RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	884903	NV
2	163W00000X	Registered Nurse	95349510	CA
3	163W00000X	Registered Nurse	RN-300308	OH

General Provider Information

NPI Number	:	1861648198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MICHELLE ELAM RN

Provider Business Mailing Address
First Line	:	818 LAKENGREN DR
Second Line	:
City	:	EATON
State	:	OH
Zip	:	45320-2544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7345 S DURANGO DR STE 111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3608
Country	:	US
Telephone Number	:	702-463-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	02/27/2026

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