Provider Demographics
NPI:1356989537
Name:FARNSWORTH, ELYSE MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:MARIE
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ST. REGIS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12980
Mailing Address - Country:US
Mailing Address - Phone:518-856-9421
Mailing Address - Fax:518-856-0142
Practice Address - Street 1:92 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ST. REGIS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12980
Practice Address - Country:US
Practice Address - Phone:518-856-9421
Practice Address - Fax:518-856-0142
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY734152163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool