Provider Demographics
NPI:1679121016
Name:ELANGO, GWENDOLYN ESHIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ESHIE
Last Name:ELANGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21427 E OTTAWA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2658
Mailing Address - Country:US
Mailing Address - Phone:501-681-1583
Mailing Address - Fax:
Practice Address - Street 1:21427 E OTTAWA CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2658
Practice Address - Country:US
Practice Address - Phone:501-681-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994869-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0994869-NPOtherCOLORADO STATE BOARD OF NURSING