Provider Demographics
NPI:1447622295
Name:MICHNOWICZ, ELISE PATRICIA (NP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:PATRICIA
Last Name:MICHNOWICZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:ENGELHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:
Practice Address - Street 1:1821 HILLANDALE RD
Practice Address - Street 2:SUITE 24B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2659
Practice Address - Country:US
Practice Address - Phone:919-383-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner