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Individual

ELIZABETH FAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, PA-C

Contact information

Practice address
1400 JACKSON ST, DENVER, CO 80206-2761
(303) 388-4461
(303) 398-1211
Mailing address
1400 JACKSON ST, DENVER, CO 80206-2761
(303) 388-4461
(303) 398-1211

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004030
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1992197974
CO
05
28759311
CO
01
404481YLSH
MEDICARE PTAN
CO
Enumeration date
02/27/2015
Last updated
02/22/2021
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