Provider Demographics
NPI:1992421531
Name:HARLESS, ELIZABETH OUZTS (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OUZTS
Last Name:HARLESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S DAVIE ST APT 314
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2859
Mailing Address - Country:US
Mailing Address - Phone:336-840-4054
Mailing Address - Fax:
Practice Address - Street 1:1011 HIGH POINT ST
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-7192
Practice Address - Country:US
Practice Address - Phone:336-498-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant