Provider Demographics
NPI:1770289944
Name:ELLIOTT, TERESA RENE (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:RENE
Last Name:ELLIOTT
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 1:8444 N 90TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4437
Mailing Address - Country:US
Mailing Address - Phone:480-977-1438
Mailing Address - Fax:
Practice Address - Street 1:42 E CRESCENTVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1302
Practice Address - Country:US
Practice Address - Phone:513-671-7117
Practice Address - Fax:513-671-7110
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.207558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse