Individual
ELIZABETH ABAGAIL MIDYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
(505) 661-8916
Mailing address
PO BOX 66156, BATON ROUGE, LA 70896-6156
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
324685
LA
363AM0700X
Medical Physician Assistant
Primary
PA2023-0235
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2023-0235
NM MEDICAL BOARD
NM
Enumeration date
08/22/2019
Last updated
08/09/2023
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