Provider Demographics
NPI:1134575962
Name:HARTSHORN, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HARTSHORN
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 1:330 HOLGUIN RD
Mailing Address - Street 2:
Mailing Address - City:VADO
Mailing Address - State:NM
Mailing Address - Zip Code:88072-7220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 HOLGUIN RD
Practice Address - Street 2:
Practice Address - City:VADO
Practice Address - State:NM
Practice Address - Zip Code:88072-7220
Practice Address - Country:US
Practice Address - Phone:575-233-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42575163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool