Provider Demographics
NPI:1639354251
Name:PENFOLD, ELIZABETH ANN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PENFOLD
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:14155 N 83RD AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5640
Mailing Address - Country:US
Mailing Address - Phone:602-264-9044
Mailing Address - Fax:602-264-0057
Practice Address - Street 1:740 E HIGHLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3609
Practice Address - Country:US
Practice Address - Phone:602-264-9044
Practice Address - Fax:602-264-0057
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2017-05-24
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Provider Licenses
StateLicense IDTaxonomies
AZ3730363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ506162Medicaid