MEDICARE: ELLE NP IN FAMILY HEALTH, PLLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1932769361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLE NP IN FAMILY HEALTH, PLLC

Provider Business Mailing Address
First Line	:	1203 AMSTERDAM RD APT 7A
Second Line	:
City	:	SCOTIA
State	:	NY
Zip	:	12302-6345
Country	:	US
Telephone Number	:	914-645-3539
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CHURCH ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-8654
Country	:	US
Telephone Number	:	518-450-7360
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MISS MIRABELLE BECK
Credential	:	FNP
Telephone Number	:	914-645-3539

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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