Provider Demographics
NPI:1134958242
Name:DERHAMMER, ELIZABETH MARIE (FNP-C, APRN-CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:DERHAMMER
Suffix:
Gender:F
Credentials:FNP-C, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9534
Mailing Address - Country:US
Mailing Address - Phone:330-241-1767
Mailing Address - Fax:
Practice Address - Street 1:8611 RYAN RD
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9534
Practice Address - Country:US
Practice Address - Phone:330-241-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN356253163WG0000X
OHAPRN.CNP.0037269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice