Provider Demographics
NPI:1366130445
Name:HOLCOMBE, ELISE DANIEL (RN)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:DANIEL
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8988 SE AUGUSTINE CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3046
Mailing Address - Country:US
Mailing Address - Phone:503-519-4790
Mailing Address - Fax:503-908-6172
Practice Address - Street 1:11211 SE 82ND AVE STE K
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7641
Practice Address - Country:US
Practice Address - Phone:503-575-9845
Practice Address - Fax:503-908-6172
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR092007031163WW0101X, 163WX0800X, 163W00000X
171400000X, 174H00000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer