Provider Demographics
NPI:1861638462
Name:STARKS, ELIZABETH SCIME (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SCIME
Last Name:STARKS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:SCIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5547 VIA MARINA
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2841
Mailing Address - Country:US
Mailing Address - Phone:716-639-0139
Mailing Address - Fax:
Practice Address - Street 1:5547 VIA MARINA
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2841
Practice Address - Country:US
Practice Address - Phone:716-639-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283101-1163WG0000X, 163WH0200X, 163WN0003X, 163WA2000X, 163WC0400X
OH283101-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator