Provider Demographics
NPI:1891033742
Name:ELKINS, JERA ELLEN (LVN)
Entity type:Individual
Prefix:
First Name:JERA
Middle Name:ELLEN
Last Name:ELKINS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39620 BONAIRE WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2550
Mailing Address - Country:US
Mailing Address - Phone:951-816-0294
Mailing Address - Fax:
Practice Address - Street 1:39620 BONAIRE WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2550
Practice Address - Country:US
Practice Address - Phone:951-816-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 98249164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse