Provider Demographics
NPI:1790473585
Name:JOSEPH, ELISA RENEE (RN)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:RENEE
Last Name:JOSEPH
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 1:3122 NW EXPRESSWAY APT 194
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4021
Mailing Address - Country:US
Mailing Address - Phone:405-694-0763
Mailing Address - Fax:
Practice Address - Street 1:1701 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-1401
Practice Address - Country:US
Practice Address - Phone:405-694-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207617163WA2000X, 163WL0100X, 163WC1500X, 163WH0200X, 163WM0102X, 163WN1003X, 163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support