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General NPI Number Information
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NPI Number | 1467163162
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Entity Type | Individual
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Provider Name | ELISE NOELLE MARCOTTE PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 895 7TH ST E
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City | SAINT PAUL
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State | MN
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Zip | 55106-3871
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Country | US
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Telephone | 651-504-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 895 7TH ST E
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City | SAINT PAUL
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State | MN
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Zip | 55106-3871
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Country | US
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Telephone | 612-669-0999
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 14655
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License Number State | MN
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