Individual
ELIZABETH FAITH LEQUAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
950 N MERIDIAN ST, INDIANAPOLIS, IN 46204-1077
(317) 963-2200
(317) 963-1621
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002331A
IN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430F49
MEDICARE PTAN
IN
05
—
300007450
—
IN
Enumeration date
06/22/2017
Last updated
02/12/2024
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