Provider Demographics
NPI:1710200670
Name:ALLEN, ELIZABETH L (NP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:185 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2102
Mailing Address - Country:US
Mailing Address - Phone:315-798-5080
Mailing Address - Fax:315-798-5022
Practice Address - Street 1:406 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2306
Practice Address - Country:US
Practice Address - Phone:315-798-5747
Practice Address - Fax:315-798-1057
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178545-1163W00000X
NYF380166-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400029541Medicare PIN