Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 28198875A | IN |
NPI | 1013505668 |
---|---|
Provider Name | Elizabeth W Maina |
First Address | Elkhart, IN 46516-4666 |
Second Address | Elkhart, IN 46516-4666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2021 |
Last Update Date | 08/01/2021 |