Provider Demographics
NPI:1003479429
Name:DARBY, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:PANAGIOTIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13994 SUSANNA CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13994 SUSANNA CT
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4988
Practice Address - Country:US
Practice Address - Phone:734-812-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299237163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine