Provider Demographics
NPI:1316538119
Name:BIDWELL, ELIJAH CAIN (APRN-CRNA)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:CAIN
Last Name:BIDWELL
Suffix:
Gender:M
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838-1943
Mailing Address - Country:US
Mailing Address - Phone:915-303-6564
Mailing Address - Fax:
Practice Address - Street 1:4845 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-5666
Practice Address - Fax:915-215-5047
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029155367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered