Provider Demographics
NPI:1003048349
Name:ADISA, ELIZABETH BEAUTY
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BEAUTY
Last Name:ADISA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:BEAUTY
Other - Last Name:ITSEMIYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:609 HEMPSTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2225
Mailing Address - Country:US
Mailing Address - Phone:516-570-3471
Mailing Address - Fax:516-570-3471
Practice Address - Street 1:609 HEMPSTEAD BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2225
Practice Address - Country:US
Practice Address - Phone:516-570-3471
Practice Address - Fax:516-570-3471
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse