Provider Demographics
NPI:1295403848
Name:PAVELONIS, ELLE R
Entity Type:Individual
Prefix:
First Name:ELLE
Middle Name:R
Last Name:PAVELONIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 N 54TH CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4503
Mailing Address - Country:US
Mailing Address - Phone:602-503-7231
Mailing Address - Fax:
Practice Address - Street 1:3830 N 54TH CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4503
Practice Address - Country:US
Practice Address - Phone:602-503-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN212513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse