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General NPI Number Information
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NPI Number | 1619314622
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Entity Type | Individual
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Provider Name | ELIZABETH CORNELIUS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 406-327-1918
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Fax | 406-329-2937
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Provider Business Mailing Address
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Address Line | 108 MARY AVE
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City | MISSOULA
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State | MT
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Zip | 59801-8706
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Country | US
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Telephone | 406-529-6079
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MED-PAC-LIC-26870
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License Number State | MT
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