Provider Demographics
NPI:1457836538
Name:IFEDIORA, ELSIE CO (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:CO
Last Name:IFEDIORA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3446
Mailing Address - Country:US
Mailing Address - Phone:214-938-0809
Mailing Address - Fax:
Practice Address - Street 1:103 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-3446
Practice Address - Country:US
Practice Address - Phone:214-938-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse