Provider Demographics
NPI:1396199626
Name:ELDERSHAW, PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ELDERSHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 STATE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04757-4119
Mailing Address - Country:US
Mailing Address - Phone:207-227-4153
Mailing Address - Fax:
Practice Address - Street 1:871 STATE RD
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:ME
Practice Address - Zip Code:04757-4119
Practice Address - Country:US
Practice Address - Phone:207-227-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN63104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse