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General NPI Number Information
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NPI Number | 1134780182
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Entity Type | Individual
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Provider Name | ELIZABETH RODENBUSH
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 20 FOXCROSS CIR
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City | CONCORD
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State | NH
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Zip | 03301-6920
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Country | US
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Telephone | 603-470-9521
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Fax |
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Provider Business Mailing Address
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Address Line | 16 HOLLY DR
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City | NORWOOD
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State | MA
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Zip | 02062-3011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA7412
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License Number State | MA
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