Provider Demographics
NPI:1407308299
Name:AUSTIN, ELIZABETH DEMETRIC
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:DEMETRIC
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 N COLE ST
Mailing Address - Street 2:APT 15
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2400
Mailing Address - Country:US
Mailing Address - Phone:419-230-5711
Mailing Address - Fax:
Practice Address - Street 1:1855 N COLE ST
Practice Address - Street 2:APT 15
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2400
Practice Address - Country:US
Practice Address - Phone:419-230-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400334360304374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide