Provider Demographics
NPI:1063461945
Name:DELLER, ELISABETH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANN
Last Name:DELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22123 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2749
Mailing Address - Country:US
Mailing Address - Phone:313-262-5736
Mailing Address - Fax:
Practice Address - Street 1:38935 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3354
Practice Address - Country:US
Practice Address - Phone:734-805-0477
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical