Provider Demographics
NPI:1285409961
Name:ELDRED, EMILY CHRISTINE (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:ELDRED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 CASTLEGATE DR W APT 2106
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8625
Mailing Address - Country:US
Mailing Address - Phone:720-579-3434
Mailing Address - Fax:
Practice Address - Street 1:2501 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2347
Practice Address - Country:US
Practice Address - Phone:818-856-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008141363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant