Provider Demographics
NPI:1922851385
Name:PUTHUR, ELIZABETH SHIJO
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHIJO
Last Name:PUTHUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SILVER SAGE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8602
Mailing Address - Country:US
Mailing Address - Phone:469-867-6011
Mailing Address - Fax:
Practice Address - Street 1:901 SILVER SAGE DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8602
Practice Address - Country:US
Practice Address - Phone:469-867-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX871213163W00000X
TX1156012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse