Provider Demographics
NPI:1962531301
Name:KROME, ELIZABETH CHADENE (RN, BSN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHADENE
Last Name:KROME
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 876051
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6051
Mailing Address - Country:US
Mailing Address - Phone:907-373-7767
Mailing Address - Fax:907-373-9867
Practice Address - Street 1:3642 N SAMS DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-4311
Practice Address - Country:US
Practice Address - Phone:907-373-7767
Practice Address - Fax:907-373-9867
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7956163W00000X
AKCM29031171M00000X
AKCMG9061251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM29031Medicaid
AK7956OtherRN LICENSE #
AKCMG9061Medicaid
AKCMG9061Medicaid