Provider Demographics
NPI:1407177975
Name:FREY, ELISA L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:L
Last Name:FREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RHOADS DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6306
Mailing Address - Country:US
Mailing Address - Phone:315-798-4350
Mailing Address - Fax:
Practice Address - Street 1:12 RHOADS DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6306
Practice Address - Country:US
Practice Address - Phone:315-798-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248215-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse