Provider Demographics
NPI:1982480786
Name:DEAN, ELISABET ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:ELISABET
Middle Name:ANNE
Last Name:DEAN
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 1:1824 ROUTE 9G LOT C6
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6188
Mailing Address - Country:US
Mailing Address - Phone:845-476-9666
Mailing Address - Fax:
Practice Address - Street 1:1824 ROUTE 9G LOT C6
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-6188
Practice Address - Country:US
Practice Address - Phone:845-476-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331015-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse