Provider Demographics
NPI:1750988457
Name:LAIRD, ELISHA (RN)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:LAIRD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:MARIE
Other - Last Name:SEVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7114 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6223
Mailing Address - Country:US
Mailing Address - Phone:605-209-4809
Mailing Address - Fax:
Practice Address - Street 1:7114 LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6223
Practice Address - Country:US
Practice Address - Phone:605-209-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX977844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse