Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 113303 | NE |
NPI | 1013526565 |
---|---|
Provider Name | Megan Renae Elliott |
First Address | Wahoo, NE 68066-5503 |
Second Address | Boys Town, NE 68010-7520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2020 |
Last Update Date | 02/09/2020 |