Provider Demographics
NPI:1003564980
Name:PRESTON, ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 N 113TH PLZ APT 5612
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5804
Mailing Address - Country:US
Mailing Address - Phone:712-579-6135
Mailing Address - Fax:
Practice Address - Street 1:529 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6242
Practice Address - Country:US
Practice Address - Phone:737-787-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114089363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty