Provider Demographics
NPI:1861748832
Name:DODS, ELIZABETH WYTYCHAK (APRN06/13/1986)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WYTYCHAK
Last Name:DODS
Suffix:
Gender:
Credentials:APRN06/13/1986
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WYTYCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN06/13/1986
Mailing Address - Street 1:222 FRONT ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-4422
Mailing Address - Country:US
Mailing Address - Phone:415-956-2884
Mailing Address - Fax:
Practice Address - Street 1:222 FRONT ST FL 6
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-4422
Practice Address - Country:US
Practice Address - Phone:415-956-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005605363LF0000X
WAAP60411118363L00000X
CT98811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid