Provider Demographics
NPI:1427191725
Name:LAREW, ELIZABETH ANNE (NP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:LAREW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GREEN MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:VA
Mailing Address - Zip Code:24248-8879
Mailing Address - Country:US
Mailing Address - Phone:865-585-1146
Mailing Address - Fax:
Practice Address - Street 1:170 BEECH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8206
Practice Address - Country:US
Practice Address - Phone:423-869-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1079900/3338POtherKY
OH08111OtherCERTIFICATE TO PRESCRIBE
OHNP08111 RN315356OtherNP LICENSE AND RN
VA0001211411OtherMULTISTATE
TNAPN0000013325OtherTN LICENSE
TNAPN0000013325OtherTN LICENSE