Provider Demographics
NPI:1962532234
Name:ELROD, JENNIFER LEE (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:ELROD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 BUENA TIERRA ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2304
Mailing Address - Country:US
Mailing Address - Phone:707-297-1297
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577905163WC0200X, 163WG0000X, 163WM0705X, 163WX0200X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Not Answered163WX0200XNursing Service ProvidersRegistered NurseOncology
Not Answered291U00000XLaboratoriesClinical Medical Laboratory