Provider Demographics
NPI:1790983088
Name:SHOWALTER, ELAINE DEANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:DEANNE
Last Name:SHOWALTER
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 1:515 S WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:IN
Mailing Address - Zip Code:46001-2441
Mailing Address - Country:US
Mailing Address - Phone:765-724-9141
Mailing Address - Fax:
Practice Address - Street 1:515 S WAYNE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-2441
Practice Address - Country:US
Practice Address - Phone:765-724-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28158301A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28158301AOtherRN