Provider Demographics
NPI:1215520507
Name:ELMORE, WALNESHIA (HOME HEALTH AID)
Entity type:Individual
Prefix:
First Name:WALNESHIA
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 INVERMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4931
Mailing Address - Country:US
Mailing Address - Phone:904-386-5036
Mailing Address - Fax:
Practice Address - Street 1:7830 INVERMERE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4931
Practice Address - Country:US
Practice Address - Phone:904-386-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide