Provider Demographics
NPI:1578992616
Name:DABILL, ELLIOTT (RN, PHN)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:DABILL
Suffix:
Gender:M
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1856
Mailing Address - Country:US
Mailing Address - Phone:707-476-2177
Mailing Address - Fax:707-476-2142
Practice Address - Street 1:808 E STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-476-2177
Practice Address - Fax:707-476-2142
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA830529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA830529OtherCALIFORNIA STATE BOARD OF REGISTERED NURSING