Provider Demographics
NPI:1487022182
Name:ELLIOTT, DANA (NP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3743 BOETTLER OAKS DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6227
Mailing Address - Country:US
Mailing Address - Phone:330-899-9100
Mailing Address - Fax:330-899-2679
Practice Address - Street 1:3743 BOETTLER OAKS DR
Practice Address - Street 2:SUITE E
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-6227
Practice Address - Country:US
Practice Address - Phone:330-899-9100
Practice Address - Fax:330-899-2679
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA 17992363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology