Healthcare Provider Details

I. General information

NPI: 1982123121
Provider Name (Legal Business Name): ELISSA WASKIEWICZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 08/27/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK STREET WOUND HEALING CENTER
GLENS FALLS NY
12801
US

IV. Provider business mailing address

100 PARK STREET WOUND HEALING CENTER
GLENS FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1522
  • Fax: 518-926-1505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342238-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: