Provider Demographics
NPI:1093020562
Name:MCAVOY, ELIZABETH HICKS (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HICKS
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 8825
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-8825
Mailing Address - Country:US
Mailing Address - Phone:203-312-5042
Mailing Address - Fax:203-746-6579
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:203-312-5042
Practice Address - Fax:203-746-6573
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336281-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily