Provider Demographics
NPI:1194036038
Name:STOSIEK, ELISE (RN BSN)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:STOSIEK
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 OLD MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1811
Mailing Address - Country:US
Mailing Address - Phone:518-523-3640
Mailing Address - Fax:518-523-4314
Practice Address - Street 1:318 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1811
Practice Address - Country:US
Practice Address - Phone:518-523-3640
Practice Address - Fax:518-523-4314
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY386391163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool