Provider Demographics
NPI:1861670598
Name:DAFOE, ELSBETH C
Entity Type:Individual
Prefix:
First Name:ELSBETH
Middle Name:C
Last Name:DAFOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 LOCKPORT RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9341
Mailing Address - Country:US
Mailing Address - Phone:716-731-6579
Mailing Address - Fax:
Practice Address - Street 1:2233 LOCKPORT RD
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9341
Practice Address - Country:US
Practice Address - Phone:716-731-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275993-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse