Healthcare Provider Details

I. General information

NPI: 1972167021
Provider Name (Legal Business Name): SIDNEY ELIZABETH EARLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIDNEY ELIZABETH LINDELL RN

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9824 ROUTE 16
MACHIAS NY
14101-9771
US

IV. Provider business mailing address

PO BOX 188
MACHIAS NY
14101-0188
US

V. Phone/Fax

Practice location:
  • Phone: 716-353-8525
  • Fax: 716-353-8272
Mailing address:
  • Phone: 716-353-8525
  • Fax: 716-353-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number647055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: