Healthcare Provider Details

I. General information

NPI: 1124436944
Provider Name (Legal Business Name): ELIZABETH LAHAIE MSN, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 N DECATUR RD FL 2
DECATUR GA
30033-5307
US

IV. Provider business mailing address

200 N HIGHLAND AVE NE UNIT 303
ATLANTA GA
30307-5624
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number670896-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN9315157
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number274128
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: