Provider Demographics
NPI:1154306942
Name:MCKINLEY, ELIZABETH WARD (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WARD
Last Name:MCKINLEY
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:PO BOX 664
Mailing Address - Street 2:601 ELMWOOD AVENUE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-275-3271
Mailing Address - Fax:585-442-2949
Practice Address - Street 1:601 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-275-3271
Practice Address - Fax:585-442-2949
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333969225400000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q46696Medicare UPIN
Q46696Medicare ID - Type Unspecified