Provider Demographics
NPI:1518414341
Name:ELTIAR, MONA (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:
Last Name:ELTIAR
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5120
Mailing Address - Country:US
Mailing Address - Phone:817-337-8884
Mailing Address - Fax:817-337-8075
Practice Address - Street 1:1921 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5120
Practice Address - Country:US
Practice Address - Phone:817-337-8884
Practice Address - Fax:817-337-8075
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily