Provider Demographics
NPI:1780095539
Name:ELDER, PATRICIA ALICE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ALICE
Last Name:ELDER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ALICE
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1648 VIA ARRIBA
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1233
Mailing Address - Country:US
Mailing Address - Phone:310-378-1958
Mailing Address - Fax:
Practice Address - Street 1:1648 VIA ARRIBA
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1233
Practice Address - Country:US
Practice Address - Phone:310-378-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304850163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant