Provider Demographics
NPI:1710087333
Name:PISCHEL, ELIZABETH ANN (CNM)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PISCHEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S HOLLY ST
Mailing Address - Street 2:GREENTREE
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3113
Mailing Address - Country:US
Mailing Address - Phone:541-774-8044
Mailing Address - Fax:541-774-7977
Practice Address - Street 1:140 S HOLLY ST
Practice Address - Street 2:GREENTREE
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3113
Practice Address - Country:US
Practice Address - Phone:541-774-8044
Practice Address - Fax:541-774-7977
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR085085574N5NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ48559Medicare UPIN
131971Medicare PIN