Provider Demographics
NPI:1629307772
Name:STRATTON, ELIZABETH ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:STRATTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10042 SWITCHYARD DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8115
Mailing Address - Country:US
Mailing Address - Phone:336-944-5566
Mailing Address - Fax:
Practice Address - Street 1:200 QUEENS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3253
Practice Address - Country:US
Practice Address - Phone:704-333-7376
Practice Address - Fax:704-333-3397
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002030363AM0700X
NC0010-02030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3036AOtherMEDICARE PTAN
NCNC3036BMedicare PIN