Healthcare Provider Details

I. General information

NPI: 1093480741
Provider Name (Legal Business Name): ELIZABETH ANN SABIC NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 04/20/2022
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-2645
US

IV. Provider business mailing address

601 ELMWOOD AVE # 777
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7744
  • Fax:
Mailing address:
  • Phone: 585-275-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383263
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number383263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: