Healthcare Provider Details

I. General information

NPI: 1922238070
Provider Name (Legal Business Name): ELIZABETH ANN SCANNELL RN, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 POWELL AVE
NEWBURGH NY
12550-3412
US

IV. Provider business mailing address

40 CARLY DR
HIGHLAND NY
12528-2731
US

V. Phone/Fax

Practice location:
  • Phone: 845-569-3358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244475-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: