MEDICARE: ELIZABETH A ELIAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	445332	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	16-1039939	OTHER	NY	ALL OTHER INSURNACE

General Provider Information

NPI Number	:	1861738759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A ELIAS

Provider Business Mailing Address
First Line	:	139 TRAPPING BROOK RD
Second Line	:
City	:	WELLSVILLE
State	:	NY
Zip	:	14895-9465
Country	:	US
Telephone Number	:	607-331-4815
Fax Number	:

Provider Business Practice Location Address
First Line	:	7309 SENECA RD N
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-9691
Country	:	US
Telephone Number	:	607-282-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	08/26/2021

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