Provider Demographics
NPI:1477245231
Name:DOE, ELVIRA B
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:B
Last Name:DOE
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 1:1002 MAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9231
Mailing Address - Country:US
Mailing Address - Phone:515-305-7434
Mailing Address - Fax:
Practice Address - Street 1:1002 MAYWOOD LN
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9231
Practice Address - Country:US
Practice Address - Phone:515-305-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker