Provider Demographics
NPI:1063714319
Name:ELIZIER, ROSE LAURE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:LAURE
Last Name:ELIZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BEAVER DAM DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5673
Mailing Address - Country:US
Mailing Address - Phone:347-242-1136
Mailing Address - Fax:
Practice Address - Street 1:8825 163RD ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4046
Practice Address - Country:US
Practice Address - Phone:718-739-0045
Practice Address - Fax:718-739-0102
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY746875163W00000X
PARN729837163W00000X
NY299988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse