Individual
ELYSSA HAGEN MAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
713 HARRISON ST, SYRACUSE, NY 13210-2305
(315) 464-3105
Mailing address
713 HARRISON ST, SYRACUSE, NY 13210-2305
(315) 464-3105
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
727162
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403516
NY
Other
Enumeration date
05/07/2021
Last updated
06/21/2021
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