Provider Demographics
NPI:1720697501
Name:DOTY, ELIZABETH DIANE (DNAP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DIANE
Last Name:DOTY
Suffix:
Gender:F
Credentials:DNAP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DIANE
Other - Last Name:COPPEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 BEAVERCREEK RD STE 101-391
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4301
Mailing Address - Country:US
Mailing Address - Phone:503-309-0571
Mailing Address - Fax:
Practice Address - Street 1:235 N CONEJO SCHOOL RD APT 116
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2676
Practice Address - Country:US
Practice Address - Phone:503-309-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202004994CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered