Provider Demographics
NPI:1679509012
Name:ELLIOTT, DARLENE NELLE (CNP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:NELLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:NELLE
Other - Last Name:SHUMWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PRESBYTERIAN HEALTHCARE SERVICES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:
Practice Address - Street 1:200 EMILIO LOPEZ RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6818
Practice Address - Country:US
Practice Address - Phone:505-866-2700
Practice Address - Fax:505-866-2737
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Q7439Medicaid
NMS74467Medicare UPIN