Healthcare Provider Details

I. General information

NPI: 1609866805
Provider Name (Legal Business Name): ELIZABETH MARIE PRINTUP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MOUNT HOPE RD
LEWISTON NY
14092-9762
US

IV. Provider business mailing address

2015 MOUNT HOPE RD
LEWISTON NY
14092-9762
US

V. Phone/Fax

Practice location:
  • Phone: 716-297-0310
  • Fax: 716-297-1562
Mailing address:
  • Phone: 716-297-0310
  • Fax: 716-297-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330936-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: