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Individual
DEBRA SUSAN ELY
Active
Individual
DEBRA SUSAN ELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001330
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26592
WELLMARK BCBS
IA
Enumeration date
09/27/2005
Last updated
11/29/2007
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