Provider Demographics
NPI:1174009930
Name:ELLWOOD-DIGEL, FAUN (PA-C)
Entity Type:Individual
Prefix:
First Name:FAUN
Middle Name:
Last Name:ELLWOOD-DIGEL
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 1:275 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2295
Mailing Address - Country:US
Mailing Address - Phone:303-604-6319
Mailing Address - Fax:
Practice Address - Street 1:275 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2295
Practice Address - Country:US
Practice Address - Phone:303-604-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant