Provider Demographics
NPI:1982926440
Name:ELISHA, JEANNE A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:A
Last Name:ELISHA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FERRY STREET
Mailing Address - Street 2:RUSSELL SAGE COLLEGE ATTENTION WELLNESS CENTER
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-244-2261
Mailing Address - Fax:518-244-2262
Practice Address - Street 1:45 FERRY STREET
Practice Address - Street 2:TROY NY RUSSELL SAGE COLLEGE
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-244-2261
Practice Address - Fax:518-244-2262
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner