Provider Demographics
NPI:1013385103
Name:MCGOURTY, ELIZABETH (NP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCGOURTY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STATE ROUTE 31
Mailing Address - Street 2:STE 111
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4953
Mailing Address - Country:US
Mailing Address - Phone:908-281-0632
Mailing Address - Fax:908-281-9848
Practice Address - Street 1:111 STATE ROUTE 31 STE 111
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4953
Practice Address - Country:US
Practice Address - Phone:908-284-9880
Practice Address - Fax:908-782-4316
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00571200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health