Healthcare Provider Details

I. General information

NPI: 1710289848
Provider Name (Legal Business Name): ELIZABETH KATHRINE SCHAEFER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 07/15/2024
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 PROSPERITY CROSSING DR STE 2200
CHARLOTTE NC
28269-2206
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-863-9830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02623
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: