Provider Demographics
NPI:1467264176
Name:GUTTMANN, ELISSA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:RAE
Last Name:GUTTMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:GUTTMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2730 S VAL VISTA DR STE 177
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1683
Mailing Address - Country:US
Mailing Address - Phone:480-394-0200
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR STE 177
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1683
Practice Address - Country:US
Practice Address - Phone:480-394-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant