Provider Demographics
NPI:1902848070
Name:ELLIOTT, WANDA (LSA)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-867-4004
Mailing Address - Fax:281-359-2811
Practice Address - Street 1:601 ROCKMEAD DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2107
Practice Address - Country:US
Practice Address - Phone:713-486-7400
Practice Address - Fax:281-359-2811
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00037246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant