Provider Demographics
NPI:1114399599
Name:CARRIGAN, ELIZABETH MARIE
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:MANCUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4820 W TAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2800
Mailing Address - Country:US
Mailing Address - Phone:315-448-6215
Mailing Address - Fax:
Practice Address - Street 1:4820 W TAFT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2800
Practice Address - Country:US
Practice Address - Phone:315-448-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339778-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily