Provider Demographics
NPI:1891045209
Name:SLATES, ELIZABETH (CNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SLATES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 MORSE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3458
Mailing Address - Country:US
Mailing Address - Phone:614-476-4101
Mailing Address - Fax:614-476-4101
Practice Address - Street 1:5175 MORSE RD
Practice Address - Street 2:STE 300
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3458
Practice Address - Country:US
Practice Address - Phone:614-476-4101
Practice Address - Fax:614-476-4101
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.13635163W00000X
OH318633363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse