Basic Information
Provider Information
NPI: 1487197794
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANTRIP
FirstName: ELAINA
MiddleName: REUEL
NamePrefix:  
NameSuffix:  
Credential: APRN (PNP)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 HARVARD WAY
Address2:  
City: RENO
State: NV
PostalCode: 895022055
CountryCode: US
TelephoneNumber: 7759825262
FaxNumber: 7759825496
Practice Location
Address1: 901 E 2ND ST STE 201
Address2:  
City: RENO
State: NV
PostalCode: 895021186
CountryCode: US
TelephoneNumber: 7759825000
FaxNumber: 7759823971
Other Information
ProviderEnumerationDate: 11/18/2016
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XAPRN002338NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


Home