Provider Demographics
NPI:1669640249
Name:MCELRATH, HATTIE MARCIA (RN)
Entity Type:Individual
Prefix:
First Name:HATTIE
Middle Name:MARCIA
Last Name:MCELRATH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-8956
Mailing Address - Country:US
Mailing Address - Phone:231-398-0323
Mailing Address - Fax:
Practice Address - Street 1:395 3RD ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1718
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-723-1735
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704159747OtherSTATE OF MICHIGAN LICENSE