Provider Demographics
NPI:1023170347
Name:VON SCHULENBURG, ELSA H (MD)
Entity type:Individual
Prefix:MS
First Name:ELSA
Middle Name:H
Last Name:VON SCHULENBURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4800 ALPINE PL
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4084
Mailing Address - Country:US
Mailing Address - Phone:702-851-3572
Mailing Address - Fax:702-851-3574
Practice Address - Street 1:4800 ALPINE PL
Practice Address - Street 2:SUITE 10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4084
Practice Address - Country:US
Practice Address - Phone:702-851-3572
Practice Address - Fax:702-851-3574
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018302Medicaid