Provider Demographics
NPI:1912466558
Name:GADE, ELAINE LYNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:LYNETTE
Last Name:GADE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2345 E SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5419
Mailing Address - Country:US
Mailing Address - Phone:480-893-2345
Mailing Address - Fax:
Practice Address - Street 1:2345 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5419
Practice Address - Country:US
Practice Address - Phone:808-932-3454
Practice Address - Fax:480-926-0495
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8254363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical