Healthcare Provider Details

I. General information

NPI: 1598116121
Provider Name (Legal Business Name): ELIZABETH C PETERS N.P., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E HENRIETTA RD
ROCHESTER NY
14620-4684
US

IV. Provider business mailing address

1870 WINTON RD S STE 100
ROCHESTER NY
14618-4011
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-6500
  • Fax:
Mailing address:
  • Phone: 585-276-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307731-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number307731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: