Provider Demographics
NPI:1194036269
Name:ELLIOTT, AMELIA ELISABETH CANRIGHT (PA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELISABETH CANRIGHT
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ELISABETH
Other - Last Name:CANRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 NW ELKS DR STE 101
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3744
Practice Address - Country:US
Practice Address - Phone:541-768-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003759363A00000X
ORPA222049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003759OtherLICENSE
VA0110004231OtherLICENSE