Provider Demographics
NPI:1922424217
Name:RAINES AZWELL, ELIZABETH ANN (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:RAINES AZWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N SALADO AVE
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2522
Mailing Address - Country:US
Mailing Address - Phone:209-895-7999
Mailing Address - Fax:209-892-0691
Practice Address - Street 1:55 N SALADO AVE
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2522
Practice Address - Country:US
Practice Address - Phone:209-895-7999
Practice Address - Fax:209-892-0691
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily