Healthcare Provider Details

I. General information

NPI: 1225084387
Provider Name (Legal Business Name): ELIZABETH ANNE DENAUW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ANNE DOAK PA-C

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FIRST ST
COLEBROOK NH
03576-3128
US

IV. Provider business mailing address

94 INDIAN STREAM RD
PITTSBURG NH
03592-5102
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-4262
  • Fax:
Mailing address:
  • Phone: 603-630-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0228
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: