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General NPI Number Information
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NPI Number | 1801383575
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Entity Type | Individual
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Provider Name | ELIZABETH D VENEGAS APRN
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Gender | Female
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 3991 DUTCHMANS LN STE 310
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City | LOUISVILLE
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State | KY
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Zip | 40207-4716
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Country | US
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Telephone | 270-789-6175
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Fax | 270-789-3157
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3012128
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License Number State | KY
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