Provider Demographics
NPI:1770569584
Name:POWLEY, ELIZABETH A (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:POWLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 679 T
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3760
Mailing Address - Fax:585-273-1129
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0002
Practice Address - Country:US
Practice Address - Phone:585-273-3760
Practice Address - Fax:585-273-1129
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332223-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02693350Medicaid
NY02693350Medicaid
NYRA8668Medicare ID - Type UnspecifiedMEDICARE
NYP09594Medicare UPIN