Provider Demographics
NPI:1447440557
Name:ACANFORA, ELIZABETH A (RN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:ACANFORA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 COPES CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13843-2191
Mailing Address - Country:US
Mailing Address - Phone:607-783-2743
Mailing Address - Fax:
Practice Address - Street 1:561 COPES CORNERS RD
Practice Address - Street 2:
Practice Address - City:SOUTH NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13843-2191
Practice Address - Country:US
Practice Address - Phone:607-783-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY387826-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01081570Medicaid