Healthcare Provider Details

I. General information

NPI: 1255032082
Provider Name (Legal Business Name): ELIZABETH A DEBELLA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MAIN AVE
ALBANY NY
12203-1410
US

IV. Provider business mailing address

30 N MAIN AVE
ALBANY NY
12203-1410
US

V. Phone/Fax

Practice location:
  • Phone: 518-453-6710
  • Fax:
Mailing address:
  • Phone: 518-453-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number252725
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: