Provider Demographics
NPI:1275540643
Name:DUNLEAVY, ELIZABETH M (APN,C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:DUNLEAVY
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 JUNCTION POND LN
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2925
Mailing Address - Country:US
Mailing Address - Phone:732-438-1595
Mailing Address - Fax:
Practice Address - Street 1:15 DELLWOOD LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1551
Practice Address - Country:US
Practice Address - Phone:732-545-4200
Practice Address - Fax:732-846-1089
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06442100363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7475403Medicaid
NJ7475403Medicaid