Healthcare Provider Details

I. General information

NPI: 1235894163
Provider Name (Legal Business Name): ELISE CARVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 07/22/2023
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WOLF TRAPP
PITTSFORD NY
14534-2470
US

IV. Provider business mailing address

14 WOLF TRAPP
PITTSFORD NY
14534-2470
US

V. Phone/Fax

Practice location:
  • Phone: 585-264-1021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number350015
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350015-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number409875
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: