Provider Demographics
NPI:1609574771
Name:ANDERSON, ELISHA
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97824-0141
Mailing Address - Country:US
Mailing Address - Phone:541-910-4461
Mailing Address - Fax:
Practice Address - Street 1:68287 LOWER COVE RD
Practice Address - Street 2:
Practice Address - City:COVE
Practice Address - State:OR
Practice Address - Zip Code:97824-8419
Practice Address - Country:US
Practice Address - Phone:541-910-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula