Basic Information
| Provider Information | |||||||||
| NPI: | 1912499708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMPARO | ||||||||
| FirstName: | ELMER | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056987606 | ||||||||
| FaxNumber: | 6056983774 | ||||||||
| Practice Location | |||||||||
| Address1: | 1160 VARNUM ST NE STE 317 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028544900 | ||||||||
| FaxNumber: | 2028544910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CP001403 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | R171946 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | RN1006294 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.