Provider Demographics
NPI:1881988640
Name:BIEDENBACH, ELISA ANNETTE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:ANNETTE
Last Name:BIEDENBACH
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 1:105 WILLOW POND WAY
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2619
Mailing Address - Country:US
Mailing Address - Phone:585-690-1152
Mailing Address - Fax:
Practice Address - Street 1:105 WILLOW POND WAY
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2619
Practice Address - Country:US
Practice Address - Phone:585-690-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303537-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse