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General NPI Number Information
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NPI Number | 1912714221
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Entity Type | Individual
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Provider Name | BROOKE ELZEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 777 HOSPITAL WAY
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City | POCATELLO
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State | ID
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Zip | 83201-5175
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Country | US
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Telephone | 208-239-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 6821 N COUNTY ROAD 300 W
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City | LIZTON
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State | IN
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Zip | 46149-9462
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Country | US
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Telephone | 317-446-9080
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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 | 1201006
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License Number State |
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