Individual
ELFRIEDE E VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6351 WETZEL AVE BLDG 1525, FORT CARSON, CO 80913-4188
(719) 524-4664
(719) 524-2116
Mailing address
6351 WETZEL AVE BLDG 1525, FORT CARSON, CO 80913-4188
(719) 524-4664
(719) 524-2116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA13986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA13986
LICENSE
CA
Enumeration date
05/08/2008
Last updated
05/13/2021
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