Provider Demographics
NPI:1447595913
Name:HARING, ELEANOR J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:J
Last Name:HARING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-0122
Mailing Address - Country:US
Mailing Address - Phone:970-274-1896
Mailing Address - Fax:
Practice Address - Street 1:12401 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2548
Practice Address - Country:US
Practice Address - Phone:720-848-4289
Practice Address - Fax:720-848-4293
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28926323Medicaid
CO26891YMEWMedicare PIN
CO26891YNGKMedicare PIN