Provider Demographics
NPI:1578508321
Name:FRANCE, ELIZABETH ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:FRANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETH ANN
Other - Middle Name:
Other - Last Name:FRANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3624 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7337
Mailing Address - Country:US
Mailing Address - Phone:888-227-3312
Mailing Address - Fax:406-884-2093
Practice Address - Street 1:3624 BROOKS ST STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7338
Practice Address - Country:US
Practice Address - Phone:888-227-3312
Practice Address - Fax:406-884-2093
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003993207Q00000X, 363AM0700X
MTMED-PAC-LIC-89747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8616906Medicaid
WAAB06402OtherMEDICARE GROUP #
WAAB19237Medicare PIN
WA8616906Medicaid