Provider Demographics
NPI:1164153821
Name:IMHOF, ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:IMHOF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 STATE ROUTE 63
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9404
Mailing Address - Country:US
Mailing Address - Phone:585-728-9547
Mailing Address - Fax:
Practice Address - Street 1:2350 STATE ROUTE 63
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9404
Practice Address - Country:US
Practice Address - Phone:585-728-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7-67015163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse