Provider Demographics
NPI:1588930473
Name:NEIDERT, ELAINE M (MSN, PMHNP- BC)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:NEIDERT
Suffix:
Gender:F
Credentials:MSN, PMHNP- BC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2669 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8700
Mailing Address - Country:US
Mailing Address - Phone:575-446-5300
Mailing Address - Fax:575-466-5304
Practice Address - Street 1:2669 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8700
Practice Address - Country:US
Practice Address - Phone:575-446-5300
Practice Address - Fax:575-466-5304
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA246652L364SP0808X
PASP012146363LP0808X
NMCNP02116363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health