Healthcare Provider Details

I. General information

NPI: 1609854314
Provider Name (Legal Business Name): ELIZABETH DENTON ASHE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MAIN ST STE 224A
BLACKSBURG VA
24060-4726
US

IV. Provider business mailing address

1115 BOULDERS PKWY STE 200
NORTH CHESTERFIELD VA
23225-4067
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-7133
  • Fax: 540-552-7143
Mailing address:
  • Phone: 804-560-5595
  • Fax: 804-560-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110001611
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001611
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: