Provider Demographics
NPI:1669151460
Name:NOWAK, ELIZABETH ELOISE (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELOISE
Last Name:NOWAK
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 1:1301 STONEY WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9606
Mailing Address - Country:US
Mailing Address - Phone:585-353-8446
Mailing Address - Fax:
Practice Address - Street 1:1301 STONEY WAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9606
Practice Address - Country:US
Practice Address - Phone:585-335-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333961-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse