Individual
MS. ELIZABETH ANNE LIDIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, PA-C
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-11713
NC
363AM0700X
Medical Physician Assistant
0010-11713
NC
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679240675
—
NC
Enumeration date
08/26/2021
Last updated
12/23/2024
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