Provider Demographics
NPI:1558600122
Name:HOUSER, ELKE ANNE (FNP-C, ENP-C, RN)
Entity Type:Individual
Prefix:
First Name:ELKE
Middle Name:ANNE
Last Name:HOUSER
Suffix:
Gender:F
Credentials:FNP-C, ENP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7025
Mailing Address - Country:US
Mailing Address - Phone:530-543-5623
Mailing Address - Fax:
Practice Address - Street 1:2201 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7025
Practice Address - Country:US
Practice Address - Phone:530-543-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV823378363LF0000X
CA95010055363LF0000X
MTNUR-APRN-LIC-131502363LF0000X
CARN603584163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTNUR-APRN-LIC-131502OtherSTATE OF MONTANA
CA95010055OtherCA BOARD OF REGISTERED NURSING
F07181501OtherAMERICAN ASSOCIATION OF NURSE PRACTITIONERS