Provider Demographics
NPI:1568831220
Name:MCCAMMON, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCCAMMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FEDIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8950 SERAPIS AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2600
Mailing Address - Country:US
Mailing Address - Phone:914-980-4891
Mailing Address - Fax:
Practice Address - Street 1:13210 FLORENCE AVE # 19
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4510
Practice Address - Country:US
Practice Address - Phone:562-574-2637
Practice Address - Fax:213-533-1066
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697866163W00000X
CA95159983390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse