Provider Demographics
NPI:1760647127
Name:SCISM, ELIZABETH BROOKS (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROOKS
Last Name:SCISM
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:PO BOX 470408
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-0408
Mailing Address - Country:US
Mailing Address - Phone:704-887-6402
Mailing Address - Fax:704-887-6450
Practice Address - Street 1:951 WENDOVER HEIGHT DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3565
Practice Address - Country:US
Practice Address - Phone:704-487-4677
Practice Address - Fax:704-481-8050
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004032363LF0000X, 363LG0600X
NC182608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1760647127Medicaid
NCNCK151C494OtherMEDICARE NC