Provider Demographics
NPI:1447255591
Name:ELLIOTT, SANDRA E (CNM, MSN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:E
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:EATON-RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 S COLLEGE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1302
Mailing Address - Country:US
Mailing Address - Phone:302-831-3195
Mailing Address - Fax:302-831-3193
Practice Address - Street 1:540 S COLLEGE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1302
Practice Address - Country:US
Practice Address - Phone:302-831-3195
Practice Address - Fax:302-831-3193
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10019057163W00000X
DELK0000110367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2269350000OtherAMERI HEALTH
DE7423OtherMID-ATLANTIC
DE0001030139Medicaid
DE028791YNMMOtherMEDICARE PTAN
S84641Medicare UPIN