Provider Demographics
NPI:1083863492
Name:MEADE, ELIZABETH ASHLEY (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:MEADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 COMMERCENTER W
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3303
Mailing Address - Country:US
Mailing Address - Phone:909-890-5511
Mailing Address - Fax:909-890-4599
Practice Address - Street 1:1873 COMMERCENTER W
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3303
Practice Address - Country:US
Practice Address - Phone:909-890-5511
Practice Address - Fax:909-890-4599
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18227363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner