Provider Demographics
NPI:1891143533
Name:VANHAGE, ELISABETH JILLIANNE (LPN)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:JILLIANNE
Last Name:VANHAGE
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 1:9 FUNNELL PL
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1909
Mailing Address - Country:US
Mailing Address - Phone:845-321-7399
Mailing Address - Fax:
Practice Address - Street 1:9 FUNNELL PL
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1909
Practice Address - Country:US
Practice Address - Phone:845-321-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319344-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse