Provider Demographics
NPI:1730396789
Name:WUERTEMBURG, ELAINE (RN)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:WUERTEMBURG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 DOW DR
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6200
Mailing Address - Country:US
Mailing Address - Phone:432-268-1328
Mailing Address - Fax:
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723602163WM0705X
TX171637164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse