Provider Demographics
NPI:1891303046
Name:FOX, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FOX
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 1:9049 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4926
Mailing Address - Country:US
Mailing Address - Phone:937-759-0545
Mailing Address - Fax:937-759-0549
Practice Address - Street 1:9049 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4926
Practice Address - Country:US
Practice Address - Phone:937-759-0545
Practice Address - Fax:937-759-0549
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.430793163W00000X
OHAPRN.CNP.0033191363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse