1467060814 NPI number — MRS. ANITA BROWN ELKS BA, BC-HIS

Table of content: MRS. ANITA BROWN ELKS BA, BC-HIS (NPI 1467060814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467060814 NPI number — MRS. ANITA BROWN ELKS BA, BC-HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELKS
Provider First Name:
ANITA
Provider Middle Name:
BROWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA, BC-HIS
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:
1467060814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10024 BAILEYWICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27613-6202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-244-0447
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 CREEDMOOR RD STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27613-3698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-782-3590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2020

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: 237700000X , with the licence number:  1062 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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