Provider Demographics
NPI:1750056438
Name:EXHUME, ELISABETH
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:EXHUME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:EXHUME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:70 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1219
Mailing Address - Country:US
Mailing Address - Phone:516-547-3810
Mailing Address - Fax:
Practice Address - Street 1:70 STEVENS ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1219
Practice Address - Country:US
Practice Address - Phone:516-547-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34177601164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse