Provider Demographics
NPI:1154670131
Name:ELIZEE, LYDIA (FNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:ELIZEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1063
Mailing Address - Country:US
Mailing Address - Phone:516-829-8190
Mailing Address - Fax:
Practice Address - Street 1:4519 IRIS LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1063
Practice Address - Country:US
Practice Address - Phone:516-829-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334245-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily