Provider Demographics
NPI:1194228866
Name:MCBRIDE, ELIZABETH DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANIELLE
Last Name:MCBRIDE
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 1:2901 OHIO BLVD STE 139
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2239
Mailing Address - Country:US
Mailing Address - Phone:812-460-5077
Mailing Address - Fax:
Practice Address - Street 1:2901 OHIO BLVD STE 139
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2239
Practice Address - Country:US
Practice Address - Phone:812-460-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008473A363L00000X, 363L00000X
INF09180429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner