Provider Demographics
NPI:1942671045
Name:ELIZONDO, KAROL (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 PACIFIC BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-5075
Mailing Address - Country:US
Mailing Address - Phone:541-967-3888
Mailing Address - Fax:541-926-2102
Practice Address - Street 1:2730 PACIFIC BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-5075
Practice Address - Country:US
Practice Address - Phone:541-967-3888
Practice Address - Fax:541-926-2102
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606578RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse