Provider Demographics
NPI:1619619236
Name:DODGE, ELIZABETH MAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAE
Last Name:DODGE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1285 SE UNIVERSITY AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8731
Mailing Address - Country:US
Mailing Address - Phone:515-422-4984
Mailing Address - Fax:
Practice Address - Street 1:6000 UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8201
Practice Address - Country:US
Practice Address - Phone:515-241-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2023-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA121585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant