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General NPI Number Information
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NPI Number | 1932202082
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Entity Type | Individual
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Provider Name | ELIZABETH ANN PAVAO FNP, RNFA
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-2934
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Fax | 207-662-6389
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Provider Business Mailing Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-2934
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Fax | 207-662-6389
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN45048
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11680
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP81333
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License Number State | ME
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