Provider Demographics
NPI:1184085847
Name:PITTMAN, ELIZIBETH D (NP-C)
Entity type:Individual
Prefix:
First Name:ELIZIBETH
Middle Name:D
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-3482
Mailing Address - Country:US
Mailing Address - Phone:618-841-1166
Mailing Address - Fax:
Practice Address - Street 1:2330 LYNCH RD STE 100
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-2998
Practice Address - Country:US
Practice Address - Phone:812-867-9800
Practice Address - Fax:812-867-4720
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006110A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201352650Medicaid
KY7100395510Medicaid
IN229920003Medicare PIN