Individual
CAROLYN ELMBORG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5752 RIDGE TRL, JOPLIN, MO 64804-9506
(417) 437-0357
(417) 624-5741
Mailing address
5752 RIDGE TRL, JOPLIN, MO 64804-9506
(417) 437-0357
(417) 624-5741
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
056659
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100254890A
—
KS
05
—
100788290A
—
OK
01
—
430027953
RR MEDICARE
—
05
—
913006409
—
MO
Enumeration date
05/20/2006
Last updated
04/11/2011
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