Provider Demographics
NPI:1558887414
Name:ELAIGU, FAITH (RN)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:ELAIGU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10045 205TH PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10045 205TH PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11423-3436
Practice Address - Country:US
Practice Address - Phone:862-703-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-01-17
Deactivation Date:2018-12-17
Deactivation Code:
Reactivation Date:2022-01-14
Provider Licenses
StateLicense IDTaxonomies
NY328991-1164W00000X
NY328991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty