Provider Demographics
NPI:1033417787
Name:JOHN, ELIZABETH (NP, RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:STANLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, RN
Mailing Address - Street 1:273 ROSELLE ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-747-0804
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30304817363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health