Provider Demographics
NPI:1972061695
Name:STONE, ELIZABETH MARIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1831
Mailing Address - Country:US
Mailing Address - Phone:865-776-7470
Mailing Address - Fax:
Practice Address - Street 1:200 UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1831
Practice Address - Country:US
Practice Address - Phone:865-776-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0005710OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES