Provider Demographics
NPI:1194896472
Name:ELZY, BREE DANIELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:BREE
Middle Name:DANIELLE
Last Name:ELZY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 SOUTHWEST BLVD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3971
Mailing Address - Country:US
Mailing Address - Phone:330-766-0685
Mailing Address - Fax:
Practice Address - Street 1:1839 SOUTHWEST BLVD SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3971
Practice Address - Country:US
Practice Address - Phone:330-766-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 110576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2383013Medicaid