Provider Demographics
NPI:1144819780
Name:LERMA, ELENA (RN, BSN, SRNA)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:LERMA
Suffix:
Gender:F
Credentials:RN, BSN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 W LOTUS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-1618
Mailing Address - Country:US
Mailing Address - Phone:682-583-2645
Mailing Address - Fax:
Practice Address - Street 1:2063 W LOTUS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-1618
Practice Address - Country:US
Practice Address - Phone:682-583-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL041544620367500000X
IL209029336367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherNONE