Provider Demographics
NPI:1366851313
Name:ELIZALDE, NORA PATRICIA (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:PATRICIA
Last Name:ELIZALDE
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-3106
Mailing Address - Country:US
Mailing Address - Phone:806-414-2703
Mailing Address - Fax:
Practice Address - Street 1:2330 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2372
Practice Address - Country:US
Practice Address - Phone:620-624-0463
Practice Address - Fax:620-624-7313
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK214590363LW0102X
KS149452363LW0102X
KS149453367A00000X
OKR0076653367A00000X
KS76551367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health