Provider Demographics
NPI:1063291458
Name:ELMORE, NICHOLAS MARSHALL
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MARSHALL
Last Name:ELMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23317 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-8209
Mailing Address - Country:US
Mailing Address - Phone:225-323-7129
Mailing Address - Fax:
Practice Address - Street 1:23317 CONIFER DR
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-8209
Practice Address - Country:US
Practice Address - Phone:225-323-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator