Provider Demographics
NPI:1457886350
Name:ELIAS, JANE ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ASHLEY
Last Name:ELIAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ASHLEY
Other - Last Name:OSIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18302 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-5007
Mailing Address - Country:US
Mailing Address - Phone:248-478-1500
Mailing Address - Fax:
Practice Address - Street 1:18302 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5007
Practice Address - Country:US
Practice Address - Phone:248-478-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294189163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457886350Medicaid
14197691OtherCAQH