Provider Demographics
NPI:1184642415
Name:PREVETTE, ELIZABETH RENEE (ANP-BC, DACHM)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RENEE
Last Name:PREVETTE
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Gender:F
Credentials:ANP-BC, DACHM
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Mailing Address - Street 1:3033 N CENTRAL AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2808
Mailing Address - Country:US
Mailing Address - Phone:623-583-3001
Mailing Address - Fax:623-974-6721
Practice Address - Street 1:1705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6920
Practice Address - Country:US
Practice Address - Phone:480-964-2273
Practice Address - Fax:480-718-9477
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-03-18
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Provider Licenses
StateLicense IDTaxonomies
AZAP2416363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119371Medicaid
AZZ133891Medicare PIN
AZ119371Medicaid
Q72223Medicare UPIN