Healthcare Provider Details

I. General information

NPI: 1366056079
Provider Name (Legal Business Name): ELIZABETH HALPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W MAIN ST
AVON NY
14414-1145
US

IV. Provider business mailing address

229 W MAIN ST
AVON NY
14414-1145
US

V. Phone/Fax

Practice location:
  • Phone: 252-451-7575
  • Fax:
Mailing address:
  • Phone: 252-451-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number310227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: