Provider Demographics
NPI:1679907364
Name:ROPER, ELENA (LPN)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:
Last Name:ROPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-27 210TH STREET
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1511
Mailing Address - Country:US
Mailing Address - Phone:917-628-3325
Mailing Address - Fax:
Practice Address - Street 1:94-27 210TH STREET
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1511
Practice Address - Country:US
Practice Address - Phone:917-628-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292192164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse