Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 24865 | NE |
N | 207RR0500X | Rheumatology | MD428987 | PA |
NPI | 1093823437 |
---|---|
Provider Name | Jennifer Rae Elliott |
First Address | Lincoln, NE 68506-1566 |
Second Address | Lincoln, NE 68506-1566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 22/10/2009 |