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General NPI Number Information
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NPI Number | 1417580705
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Entity Type | Individual
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Provider Name | ELIZABETH FAY WASYLOW
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Gender | Female
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Dates
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Enumeration Date | 02/15/2020
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 1022 COUNTY ROAD 28
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City | SCOTTSBORO
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State | AL
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Zip | 35768-6458
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Country | US
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Telephone | 256-609-8023
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 COUNTY ROAD 28
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City | SCOTTSBORO
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State | AL
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Zip | 35768-6458
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Country | US
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Telephone | 256-609-8023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 27528
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-081299
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License Number State | AL
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