Healthcare Provider Details

I. General information

NPI: 1649712878
Provider Name (Legal Business Name): ELIZABETH G. ANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH G SPINKS

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
YOUNGSVILLE PA
16371-1128
US

IV. Provider business mailing address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-7591
  • Fax: 814-563-9760
Mailing address:
  • Phone: 814-723-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016777
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: