Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2117756 | TX |
NPI | 1013498187 |
---|---|
Provider Name | Renee Nicole Elston |
First Address | Odessa, TX 79765-8717 |
Second Address | Odessa, TX 79762-4843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |