Provider Demographics
NPI:1629765375
Name:DUEY, ELIZABETH KATHLEEN HANNA (MSN, RN, CNS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHLEEN HANNA
Last Name:DUEY
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Gender:F
Credentials:MSN, RN, CNS
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Other - Last Name:
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Mailing Address - Street 1:119 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:917-496-0736
Mailing Address - Fax:
Practice Address - Street 1:119 PARK AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0556
Practice Address - Country:US
Practice Address - Phone:917-496-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA5037364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics