Provider Demographics
NPI:1710289848
Name:SCHAEFER, ELIZABETH KATHRINE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHRINE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5727 PROSPERITY CROSSING DR
Practice Address - Street 2:STE 2200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2206
Practice Address - Country:US
Practice Address - Phone:704-863-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
9548902OtherAETNA
NC1710289848Medicaid
NCP01299619OtherRAILROAD MEDICARE
SC88267OtherWELLCARE
SC1372PAMedicaid
NC16914OtherBCBSNC
NC8102367Medicaid
NC1710289848Medicaid
NCP01299619OtherRAILROAD MEDICARE
SC1372PAMedicaid