1972167021 NPI number — MRS. SIDNEY ELIZABETH EARLEY RN

Table of content: MRS. SIDNEY ELIZABETH EARLEY RN (NPI 1972167021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972167021 NPI number — MRS. SIDNEY ELIZABETH EARLEY RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EARLEY
Provider First Name:
SIDNEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINDELL
Provider Other First Name:
SIDNEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972167021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACHIAS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14101-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-353-8525
Provider Business Mailing Address Fax Number:
716-353-8272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9824 ROUTE 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACHIAS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14101-9771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-353-8525
Provider Business Practice Location Address Fax Number:
716-353-8272
Provider Enumeration Date:
04/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  647055 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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