Provider Demographics
NPI:1750913596
Name:DEKRYGER, ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:DEKRYGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KAY
Other - Last Name:EDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1280 E CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-2033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9384
Practice Address - Country:US
Practice Address - Phone:989-701-2538
Practice Address - Fax:989-701-2540
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011600363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical