Provider Demographics
NPI:1417422056
Name:FAW, ELVIRA N (NP)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:N
Last Name:FAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TOWER PL FL 8
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3715
Mailing Address - Country:US
Mailing Address - Phone:518-489-4471
Mailing Address - Fax:518-489-4506
Practice Address - Street 1:4 TOWER PL FL 8
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3715
Practice Address - Country:US
Practice Address - Phone:518-489-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9347623363LF0000X
NYF343880-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily