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General NPI Number Information
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NPI Number | 1992723852
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Entity Type | Individual
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Provider Name | ELIZABETH ANN COOLMAN PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 914 PINEHURST RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87124
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Country | US
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Telephone | 505-896-9412
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Fax | 505-896-9461
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Provider Business Mailing Address
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Address Line | 2605 INCA RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-7558
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Country | US
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Telephone | 321-289-8614
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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 | PA2012-0055
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9103491
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License Number State | FL
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