Provider Demographics
NPI:1659428423
Name:ERNE, SIGNE ALEXIS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:SIGNE
Middle Name:ALEXIS
Last Name:ERNE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:650 FIELDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4412
Mailing Address - Country:US
Mailing Address - Phone:706-855-2091
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL ROAD
Practice Address - Street 2:OD EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-2039
Practice Address - Fax:706-787-6004
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1018453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN