Provider Demographics
NPI:1326338161
Name:DEPIERRO, ELISA MARIE (RN, APN-C)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:MARIE
Last Name:DEPIERRO
Suffix:
Gender:F
Credentials:RN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VALLEY HEALTH PLAZA
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-634-5578
Mailing Address - Fax:201-634-5306
Practice Address - Street 1:1 VALLEY HEALTH PLAZA
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-634-5578
Practice Address - Fax:201-634-5306
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00325500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ220993WC0Medicare PIN