Provider Demographics
NPI:1497701239
Name:NORTON, ELIZABETH IRENE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:IRENE
Last Name:NORTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 DR CALVIN JONES HWY STE 212
Mailing Address - Street 2:SUITE 285
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3100
Mailing Address - Country:US
Mailing Address - Phone:919-761-5678
Mailing Address - Fax:919-761-5680
Practice Address - Street 1:620 DR CALVIN JONES HWY STE 212
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3100
Practice Address - Country:US
Practice Address - Phone:919-761-5678
Practice Address - Fax:919-761-5680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA649363A00000X
NC0010-00935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33546Medicare UPIN