1073547196 NPI number — MRS. ELIZABETH WHITE CRUZ REGISTERED NURSE

Table of content: MRS. ELIZABETH WHITE CRUZ REGISTERED NURSE (NPI 1073547196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073547196 NPI number — MRS. ELIZABETH WHITE CRUZ REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
ELIZABETH
Provider Middle Name:
WHITE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073547196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 COCHRANE CIRCLE
Provider Second Line Business Mailing Address:
ATTN MS RANKIN
Provider Business Mailing Address City Name:
FORT CARSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913-4604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-526-7649
Provider Business Mailing Address Fax Number:
719-526-7019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
PACU SDS
Provider Business Practice Location Address City Name:
FORT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-526-7015
Provider Business Practice Location Address Fax Number:
719-526-7007
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  126669 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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