Individual
MS. ELIZABETH LAUREN POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3400 SALTERBECK CT, SUITE 100, MT PLEASANT, SC 29466-7118
(843) 971-3361
(843) 971-8492
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
LL1372
SC
363AM0700X
Medical Physician Assistant
Primary
1372
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0731PA
—
SC
01
—
P00813750
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
10/28/2008
Last updated
05/22/2012
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