Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN264851 | GA |
NPI | 1063022481 |
---|---|
Provider Name | Laura Elliott |
First Address | Kennesaw, GA 30144-6732 |
Second Address | Kennesaw, GA 30144-6732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2020 |
Last Update Date | 27/01/2022 |