Provider Demographics
NPI:1972855948
Name:ELMORE, CHRISTINA ELIZABETH (CNM)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:ELMORE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3510
Mailing Address - Country:US
Mailing Address - Phone:231-866-0527
Mailing Address - Fax:
Practice Address - Street 1:760 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3510
Practice Address - Country:US
Practice Address - Phone:231-866-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICNM1176367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife