Provider Demographics
NPI:1609768795
Name:ELLIOT, JOLENE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SPRING MOUNTAIN RD STE 52
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8620
Mailing Address - Country:US
Mailing Address - Phone:725-206-5714
Mailing Address - Fax:
Practice Address - Street 1:5201 WALNUT AVE APT 71
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3629
Practice Address - Country:US
Practice Address - Phone:702-908-8297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant