Provider Demographics
NPI:1104502418
Name:LONNY ELSON FAMILY HEALTHCARE
Entity type:Organization
Organization Name:LONNY ELSON FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:928-266-1530
Mailing Address - Street 1:1016 W UNIVERSITY AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2996
Mailing Address - Country:US
Mailing Address - Phone:928-266-1530
Mailing Address - Fax:
Practice Address - Street 1:1016 W UNIVERSITY AVE STE 206
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2996
Practice Address - Country:US
Practice Address - Phone:928-266-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care