Provider Demographics
NPI:1679783054
Name:ELLIOTT-RENO, ROXANNA R (RN)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:R
Last Name:ELLIOTT-RENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROXANNA
Other - Middle Name:R
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:WY
Mailing Address - Zip Code:82730-0436
Mailing Address - Country:US
Mailing Address - Phone:307-689-0219
Mailing Address - Fax:
Practice Address - Street 1:1445 E A ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2214
Practice Address - Country:US
Practice Address - Phone:866-784-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR029543163W00000X
WY18885163WC0200X
AK7755163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine