Basic Information
| Provider Information | |||||||||
| NPI: | 1184605818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOZNIAK | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Credential: | GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 INTERNATIONAL CIR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809103139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194755065 | ||||||||
| FaxNumber: | 7194755797 | ||||||||
| Practice Location | |||||||||
| Address1: | 5920 MCINTYRE ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804037445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204344876 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 0001009 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 845737 | 05 | AZ | MEDICAID |