Provider Demographics
NPI:1972523231
Name:SMITH, ELAINE SUSAN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:SUSAN
Last Name:SMITH
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 1:1217 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1352
Mailing Address - Country:US
Mailing Address - Phone:716-372-2628
Mailing Address - Fax:
Practice Address - Street 1:465 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2658
Practice Address - Country:US
Practice Address - Phone:716-373-7709
Practice Address - Fax:716-373-8117
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332982-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily