Provider Demographics
NPI:1821460734
Name:FERRIS, ELIZABETH BROSNAHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROSNAHAN
Last Name:FERRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LEIGH
Other - Last Name:BROSNAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4420 IRVING BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5915
Mailing Address - Country:US
Mailing Address - Phone:505-727-6300
Mailing Address - Fax:505-727-9588
Practice Address - Street 1:4420 IRVING BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5915
Practice Address - Country:US
Practice Address - Phone:505-727-6300
Practice Address - Fax:505-727-9588
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09488363A00000X
WAPA60608545363A00000X
NMPA2018-0015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82802548Medicaid