Provider Demographics
NPI:1770953630
Name:TURNER, ELAINE A (PA-C)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:A
Last Name:TURNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10343 DAWSONS CREEK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1906
Mailing Address - Country:US
Mailing Address - Phone:260-203-9600
Mailing Address - Fax:260-739-6167
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-407-8006
Practice Address - Fax:260-739-6167
Is Sole Proprietor?:No
Enumeration Date:2015-10-04
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001931A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN692190069Medicare PIN