Individual
ELIZABETH MOYLE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
735 WHITE AVE, GRAND JCT, CO 81501-3441
(970) 248-5880
(970) 241-1112
Mailing address
PO BOX 1727, GRAND JUNCTION, CO 81502-1727
(970) 623-8860
(970) 623-8869
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0002780
CO
363AS0400X
Surgical Physician Assistant
2780
CO
363AS0400X
Surgical Physician Assistant
PA.0002780
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62824279
—
CO
Enumeration date
08/26/2009
Last updated
04/04/2024
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