1821489311 NPI number — SANDRA PAULETTE ELWOOD APRN CNP

Table of content: SANDRA PAULETTE ELWOOD APRN CNP (NPI 1821489311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821489311 NPI number — SANDRA PAULETTE ELWOOD APRN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELWOOD
Provider First Name:
SANDRA
Provider Middle Name:
PAULETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN CNP
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:
1821489311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 6TH AVENUE NORTH
Provider Second Line Business Mailing Address:
ST. CLOUD HOSPITAL
Provider Business Mailing Address City Name:
ST. CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-251-2700
Provider Business Mailing Address Fax Number:
320-656-7115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 6TH AVENUE NORTH
Provider Second Line Business Practice Location Address:
ST. CLOUD HOSPITAL
Provider Business Practice Location Address City Name:
ST. CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-251-2700
Provider Business Practice Location Address Fax Number:
320-656-7115
Provider Enumeration Date:
02/05/2015

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: 363LF0000X , with the licence number:  CNP 3568 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: R1698055 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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