Healthcare Provider Details

I. General information

NPI: 1205247277
Provider Name (Legal Business Name): ELINA BOYCHUK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 JOHN AVE
SCRANTON PA
18510-1439
US

IV. Provider business mailing address

821 BERNARD AVE
SOUTH ABINGTON TOWNSHIP PA
18411-9319
US

V. Phone/Fax

Practice location:
  • Phone: 718-300-2386
  • Fax:
Mailing address:
  • Phone: 718-300-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027589
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN647862
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN647862
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: