Provider Demographics
NPI:1871065136
Name:ELMER, NANCY DIANE
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:DIANE
Last Name:ELMER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:DIANE
Other - Last Name:SENSINTAFFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2257
Mailing Address - Country:US
Mailing Address - Phone:417-820-3890
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 270
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2257
Practice Address - Country:US
Practice Address - Phone:417-820-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133103163W00000X
MO2019001536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse