Provider Demographics
NPI:1386013365
Name:ATIS, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:ATIS
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 1:91-845 KAPANA PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2814
Mailing Address - Country:US
Mailing Address - Phone:808-888-2278
Mailing Address - Fax:808-888-2278
Practice Address - Street 1:91-845 KAPANA PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2814
Practice Address - Country:US
Practice Address - Phone:808-888-2278
Practice Address - Fax:808-888-2278
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020407159376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide