Provider Demographics
NPI:1396222907
Name:CORREA-DELEONARDO, ELSA VICTORIA (PMH-NP)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:VICTORIA
Last Name:CORREA-DELEONARDO
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:217 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1213
Mailing Address - Country:US
Mailing Address - Phone:410-833-0581
Mailing Address - Fax:410-833-8604
Practice Address - Street 1:217 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1213
Practice Address - Country:US
Practice Address - Phone:410-833-0581
Practice Address - Fax:410-833-8604
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR204254163WM0705X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical