Provider Demographics
NPI:1205642899
Name:LETNER, ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LETNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 DUSTY LN
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-3923
Mailing Address - Country:US
Mailing Address - Phone:928-242-3209
Mailing Address - Fax:
Practice Address - Street 1:1070 DUSTY LN
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-3923
Practice Address - Country:US
Practice Address - Phone:928-242-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158666163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory