Healthcare Provider Details

I. General information

NPI: 1396292108
Provider Name (Legal Business Name): ELIZABETH DELANCEY-NIKSA PMHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23875 COMMERCE PARK STE 140
BEACHWOOD OH
44122-5805
US

IV. Provider business mailing address

17349 FOWLES RD
MIDDLEBURG HEIGHTS OH
44130-6219
US

V. Phone/Fax

Practice location:
  • Phone: 216-532-3427
  • Fax:
Mailing address:
  • Phone: 216-235-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033697
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.390614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: