Healthcare Provider Details

I. General information

NPI: 1285391250
Provider Name (Legal Business Name): ELIZABETH MARIE SOVOCOOL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARIE WILSON NP

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ALBRO RD
MARATHON NY
13803-2808
US

IV. Provider business mailing address

85 S WEST ST
HOMER NY
13077-1542
US

V. Phone/Fax

Practice location:
  • Phone: 607-849-3180
  • Fax: 607-662-4919
Mailing address:
  • Phone: 607-753-3797
  • Fax: 607-753-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: