Provider Demographics
NPI:1558964171
Name:NIXON, ELVIRA (CNA, TMA, QSP)
Entity type:Individual
Prefix:MRS
First Name:ELVIRA
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:CNA, TMA, QSP
Other - Prefix:MS
Other - First Name:ELVIRA
Other - Middle Name:
Other - Last Name:DOVGOROUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7013 STATE RD APT 310
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4967
Mailing Address - Country:US
Mailing Address - Phone:701-410-7717
Mailing Address - Fax:
Practice Address - Street 1:2150 47TH AVE S APT 463
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3621
Practice Address - Country:US
Practice Address - Phone:218-779-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO63855376K00000X
3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care