Provider Demographics
NPI:1821416926
Name:SVOBODA, ELAINE MAE
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MAE
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:SVOBODA
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8373 UNITY DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-4005
Mailing Address - Country:US
Mailing Address - Phone:218-748-7480
Mailing Address - Fax:218-748-7488
Practice Address - Street 1:8373 UNITY DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-4005
Practice Address - Country:US
Practice Address - Phone:218-748-7480
Practice Address - Fax:218-748-7488
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant