Provider Demographics
NPI:1205009032
Name:ELLIOTT, BRENDA G (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:G
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16503 E TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-3143
Mailing Address - Country:US
Mailing Address - Phone:303-306-4217
Mailing Address - Fax:
Practice Address - Street 1:16503 E TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-3143
Practice Address - Country:US
Practice Address - Phone:303-306-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse