Provider Demographics
NPI:1679131692
Name:ELLIOTT, LISA CHERRE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:CHERRE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3030
Mailing Address - Country:US
Mailing Address - Phone:585-353-9628
Mailing Address - Fax:
Practice Address - Street 1:286 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3030
Practice Address - Country:US
Practice Address - Phone:585-353-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330423164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse