Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5006780 | NC |
NPI | 1003231705 |
---|---|
Provider Name | Michelle Sluder Elliott |
First Address | Valdese, NC 28690-9517 |
Second Address | Valdese, NC 28690-9517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003231705 | (05) | NC |