Provider Demographics
NPI:1568973287
Name:STERN, ELIZABETH CHERRY (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHERRY
Last Name:STERN
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 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:984-333-2741
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:1021 DARRINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8158
Practice Address - Country:US
Practice Address - Phone:984-333-2741
Practice Address - Fax:919-378-9114
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07372363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568973287Medicaid
NC0010-07372OtherNCMB LICENSE
NC0010-07372OtherNCMB LICENSE