Provider Demographics
NPI:1992052625
Name:NOTHERN, ELIZABETH B (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:NOTHERN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:B
Other - Last Name:VON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S PLUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1950
Mailing Address - Country:US
Mailing Address - Phone:620-431-2500
Mailing Address - Fax:620-431-1876
Practice Address - Street 1:505 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1950
Practice Address - Country:US
Practice Address - Phone:620-431-2500
Practice Address - Fax:620-431-1876
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002396363A00000X
KS1501535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant