Provider Demographics
NPI:1629158399
Name:ANDERSON, ELIZABETH JOANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOANNE
Last Name:ANDERSON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1545 68TH ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7896
Practice Address - Country:US
Practice Address - Phone:616-267-7881
Practice Address - Fax:616-267-7641
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-02-24
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Provider Licenses
StateLicense IDTaxonomies
MI5601004734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical