Provider Demographics
NPI:1083954523
Name:KHALFIN ELBAZ, ELISHEVA ROSE (MS, BSN, RN, RCST)
Entity Type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:ROSE
Last Name:KHALFIN ELBAZ
Suffix:
Gender:F
Credentials:MS, BSN, RN, RCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1815
Mailing Address - Country:US
Mailing Address - Phone:210-413-5029
Mailing Address - Fax:
Practice Address - Street 1:611 N 38TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1815
Practice Address - Country:US
Practice Address - Phone:210-413-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 172V00000X, 174H00000X, 374J00000X
PARN776960163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula