Provider Demographics
NPI:1659934495
Name:ELBERT, MAISHA I (LPN)
Entity type:Individual
Prefix:
First Name:MAISHA
Middle Name:I
Last Name:ELBERT
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 1:455 TITUS AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3547
Mailing Address - Country:US
Mailing Address - Phone:585-944-2206
Mailing Address - Fax:
Practice Address - Street 1:455 TITUS AVE APT 106
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3547
Practice Address - Country:US
Practice Address - Phone:585-944-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2024-07-19
Deactivation Date:2020-09-16
Deactivation Code:
Reactivation Date:2024-07-19
Provider Licenses
StateLicense IDTaxonomies
NY333927164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse