Healthcare Provider Details

I. General information

NPI: 1982926440
Provider Name (Legal Business Name): JEANNE A ELISHA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FERRY STREET TROY NY RUSSELL SAGE COLLEGE
TROY NY
12180
US

IV. Provider business mailing address

45 FERRY STREET RUSSELL SAGE COLLEGE ATTENTION WELLNESS CENTER
TROY NY
12180
US

V. Phone/Fax

Practice location:
  • Phone: 518-244-2261
  • Fax: 518-244-2262
Mailing address:
  • Phone: 518-244-2261
  • Fax: 518-244-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number331488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: