Provider Demographics
NPI:1336599042
Name:BAINBRIDGE, ELYSE ROCHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:ROCHELLE
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:ROCHELLE
Other - Last Name:GROCHOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 HYANNIS CT
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5818
Mailing Address - Country:US
Mailing Address - Phone:530-355-2106
Mailing Address - Fax:
Practice Address - Street 1:165 HYANNIS CT
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5818
Practice Address - Country:US
Practice Address - Phone:530-355-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant