Provider Demographics
NPI:1700507860
Name:PLANTY, ELISE LORRAINE (LM)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:LORRAINE
Last Name:PLANTY
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6937 HENNING DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-2839
Mailing Address - Country:US
Mailing Address - Phone:707-354-4776
Mailing Address - Fax:
Practice Address - Street 1:6940 DESTINY DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2987
Practice Address - Country:US
Practice Address - Phone:916-223-7731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife