Provider Demographics
NPI:1346674983
Name:ELLIOTT, STEPHEN TRADER JR (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:TRADER
Last Name:ELLIOTT
Suffix:JR
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:KAMC, NGH, MC 1, BUILDING 12, APT. 8
Mailing Address - Street 2:PO BOX 9515, ER MAIL COSE 6338
Mailing Address - City:JEDDAH
Mailing Address - State:MAKKAH
Mailing Address - Zip Code:21423
Mailing Address - Country:SA
Mailing Address - Phone:050-798-6510
Mailing Address - Fax:
Practice Address - Street 1:KAMC, NGH, MC 1, BUILDING 12, APT. 8
Practice Address - Street 2:ER MAIL COSE 6338
Practice Address - City:JEDDAH
Practice Address - State:MAKKAH
Practice Address - Zip Code:21423
Practice Address - Country:SA
Practice Address - Phone:050-798-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse