Active NPI
Sandra E Elliott, CNM, MSN
- Advanced Practice Midwife
- Newark, DE
National Provider Identifier
1447255591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- LK0000110
- Practice address
- 540 S College Ave
Suite 130
Newark, DE 19713-1302 - Phone
- (302) 831-3195
- Fax
- (302) 831-3193
- NPI assigned
- Jun 16, 2005
- Last updated
- Apr 6, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | LK0000110 | DE | Primary |
| Registered Nurse | 163W00000X | L10019057 | DE |
Addresses
Primary practice location
540 S College Ave
Suite 130
Newark, DE 19713-1302
Mailing address
540 S College Ave
Suite 130
Newark, DE 19713-1302
Phone (302) 831-3195
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001030139 | Medicaid | DE | |
| 028791YNMM | Other | DE | MEDICARE PTAN |
| 2269350000 | Other | DE | AMERI HEALTH |
| 7423 | Other | DE | MID-ATLANTIC |
Other names 1
- Sandra E Eaton-Russell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife, Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L10019057 | DE | MD | Registered Nurse |
| LK0000110 | DE | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428278400000",
"number": "1447255591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 S COLLEGE AVE",
"address_2": "SUITE 130",
"city": "NEWARK",
"state": "DE",
"postal_code": "197131302",
"telephone_number": "302-831-3195",
"fax_number": "302-831-3193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 S COLLEGE AVE",
"address_2": "SUITE 130",
"city": "NEWARK",
"state": "DE",
"postal_code": "197131302",
"telephone_number": "302-831-3195",
"fax_number": "302-831-3193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "SANDRA",
"middle_name": "E",
"name_prefix": "Mrs.",
"credential": "CNM, MSN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-16",
"last_updated": "2015-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "DE",
"license": "LK0000110",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "DE",
"license": "L10019057",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0001030139",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "028791YNMM",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERI HEALTH",
"identifier": "2269350000",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MID-ATLANTIC",
"identifier": "7423",
"state": "DE"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SANDRA",
"last_name": "EATON-RUSSELL",
"middle_name": "E",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.