Individual
LIAM KENNETH ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1300 N DUTTON AVE, SANTA ROSA, CA 95401-7112
(707) 396-5151
Mailing address
47 LANSDALE AVE, SAN ANSELMO, CA 94960-2243
(707) 483-4894
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95025942
CA
Other
Enumeration date
08/15/2023
Last updated
08/15/2023
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