Provider Demographics
NPI:1093184996
Name:KELTERBORN, ELIZABETH J (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:KELTERBORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 NORTH UNION STREET
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:347-891-1304
Mailing Address - Fax:
Practice Address - Street 1:135 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2736
Practice Address - Country:US
Practice Address - Phone:176-375-7500
Practice Address - Fax:716-806-1287
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009698363L00000X
NYF341652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04757282Medicaid
NYJ40038433OtherMEDICARE
KYP01571407OtherRAILROAD MEDICARE (KOHMG)
KY7100383990Medicaid
KY7100383990Medicaid