Provider Demographics
NPI:1629328422
Name:TOWNSEND, ELISSA D (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:D
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19472 NYS ROUTE 11
Mailing Address - Street 2:SUITE N101
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-0265
Mailing Address - Country:US
Mailing Address - Phone:315-786-1924
Mailing Address - Fax:
Practice Address - Street 1:19472 NYS ROUTE 11
Practice Address - Street 2:SUITE N101
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5004
Practice Address - Country:US
Practice Address - Phone:315-786-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily