Provider Demographics
NPI:1578756490
Name:CAULEY, ELIZABETH Q
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:Q
Last Name:CAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8365
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-8365
Mailing Address - Country:US
Mailing Address - Phone:671-649-4000
Mailing Address - Fax:671-646-0150
Practice Address - Street 1:285 FARENHOLT AVE
Practice Address - Street 2:SUITE C-311
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3223
Practice Address - Country:US
Practice Address - Phone:671-649-4000
Practice Address - Fax:671-646-0150
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU13200602117001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU657002Medicare Oscar/Certification