Provider Demographics
NPI:1053148445
Name:DAVIDE, ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DAVIDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8317 GRAYSON GREEN ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7873
Mailing Address - Country:US
Mailing Address - Phone:330-844-8148
Mailing Address - Fax:
Practice Address - Street 1:8317 GRAYSON GREEN ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7873
Practice Address - Country:US
Practice Address - Phone:330-844-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant