Provider Demographics
NPI:1093856940
Name:ROOT, ELIZABETH A (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:ROOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:2104 JOLLY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6038
Practice Address - Country:US
Practice Address - Phone:517-381-2700
Practice Address - Fax:517-381-2727
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704155806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500C313830OtherBLUE CROSS BLUE SHIELD