Healthcare Provider Details

I. General information

NPI: 1578809000
Provider Name (Legal Business Name): ELIZABETH CHURCH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LINWOOD AVE
WILLIAMSVILLE NY
14221-6501
US

IV. Provider business mailing address

46 BRIDLE PATH
ORCHARD PARK NY
14127-3026
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-9016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3165252
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: