Healthcare Provider Details

I. General information

NPI: 1700043387
Provider Name (Legal Business Name): ELIZABETH ANN OUTTEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S STATE ST
DOVER DE
19901-4112
US

IV. Provider business mailing address

1113 S STATE ST
DOVER DE
19901-4112
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-8720
  • Fax: 302-735-8724
Mailing address:
  • Phone: 302-735-8720
  • Fax: 302-735-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC50000614
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC5-0000614
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: