Provider Demographics
NPI:1730158288
Name:CZAKO, ELIZABETH KULL (CFNP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:KULL
Last Name:CZAKO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:570-882-3007
Practice Address - Street 1:7 WATER ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1126
Practice Address - Country:US
Practice Address - Phone:570-724-4241
Practice Address - Fax:570-724-5510
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331424-1363L00000X
PASP003877B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01678028Medicaid
PAGU039777OtherMEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PAGU039777OtherMEDICARE GROUP