Provider Demographics
NPI:1326593328
Name:AXE, ELIZABETH CORRIE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CORRIE
Last Name:AXE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4090
Mailing Address - Fax:717-741-3554
Practice Address - Street 1:2319 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5009
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:717-741-3554
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA249909FLTMedicare PIN