Provider Demographics
NPI:1538142658
Name:DECESARE, ELAINE MARIE (RN, ANP)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARIE
Last Name:DECESARE
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:MARIE
Other - Last Name:DESMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-2560
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646479363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health