Provider Demographics
NPI:1225084387
Name:DENAUW, ELIZABETH ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:DENAUW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:DOAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:94 INDIAN STREAM RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:NH
Mailing Address - Zip Code:03592-5102
Mailing Address - Country:US
Mailing Address - Phone:603-630-1393
Mailing Address - Fax:
Practice Address - Street 1:6 FIRST ST
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3128
Practice Address - Country:US
Practice Address - Phone:602-237-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011283Medicaid
1124751177OtherCOOS COUNTY FAMILY HEALTH
NHAP0751Medicare ID - Type Unspecified