Healthcare Provider Details

I. General information

NPI: 1144576265
Provider Name (Legal Business Name): ELIZABETH ANNE LEISER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 W GIRARD BLVD
KENMORE NY
14217
US

IV. Provider business mailing address

1150 YOUNGS RD STE 104
WILLIAMSVILLE NY
14221-8024
US

V. Phone/Fax

Practice location:
  • Phone: 716-876-0790
  • Fax:
Mailing address:
  • Phone: 716-636-7990
  • Fax: 716-929-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306078-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: