Provider Demographics
NPI:1124058789
Name:VONWELLSHEIM, ELIZABETH (GNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VONWELLSHEIM
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382B SOUTH 58TH STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478
Mailing Address - Country:US
Mailing Address - Phone:541-747-4858
Mailing Address - Fax:541-747-8351
Practice Address - Street 1:382B SOUTH 58TH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478
Practice Address - Country:US
Practice Address - Phone:541-747-4858
Practice Address - Fax:541-747-8351
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR87006599N4363LG0600X
OR087006599N4 GNPPP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161802Medicaid
ORRR PTAN 500004003Medicare PIN
S33688Medicare UPIN
ORR117749Medicare PIN
ORR100654Medicare PIN