Provider Demographics
NPI:1083863492
Name:MEADE, ELIZABETH ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:MEADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 E COLTON AVE
Mailing Address - Street 2:PO BOX 3080
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3755
Mailing Address - Country:US
Mailing Address - Phone:909-748-8021
Mailing Address - Fax:909-335-5117
Practice Address - Street 1:1200 E COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3755
Practice Address - Country:US
Practice Address - Phone:909-748-8021
Practice Address - Fax:909-335-5117
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18227363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner