Provider Demographics
NPI:1508949561
Name:CHARTERIS, ELAINE J (ANP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:J
Last Name:CHARTERIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:J
Other - Last Name:CHANECKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1775 E SKYLINE DR
Mailing Address - Street 2:#101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1162
Mailing Address - Country:US
Mailing Address - Phone:520-615-6200
Mailing Address - Fax:520-615-6255
Practice Address - Street 1:1775 E SKYLINE DR
Practice Address - Street 2:#101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1162
Practice Address - Country:US
Practice Address - Phone:520-615-6200
Practice Address - Fax:520-615-6255
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN099653363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ826951Medicaid
AZP55740Medicare UPIN