Individual
ELLIOTTE SCHAFER BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 426-2108
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 426-2108
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2024005757
MO
Other
Enumeration date
01/03/2023
Last updated
04/30/2025
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