Provider Demographics
NPI:1346892866
Name:OLIS, ELIZABETH (AGNP-BC, CNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OLIS
Suffix:
Gender:F
Credentials:AGNP-BC, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S SAINT FRANCIS DR STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4032
Mailing Address - Country:US
Mailing Address - Phone:505-920-6421
Mailing Address - Fax:833-505-2740
Practice Address - Street 1:1533 S SAINT FRANCIS DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4032
Practice Address - Country:US
Practice Address - Phone:505-920-6421
Practice Address - Fax:833-450-5254
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7202363LA2200X, 363LG0600X
NM67457363LA2200X, 363LG0600X, 363LP2300X
LARN60233163W00000X
LA219309363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02181964Medicaid