Provider Demographics
NPI:1184642415
Name:PREVETTE, ELIZABETH RENEE (ANP-BC, DACHM)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RENEE
Last Name:PREVETTE
Suffix:
Gender:F
Credentials:ANP-BC, DACHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6324 FAIRVIEW RD STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4172
Practice Address - Country:US
Practice Address - Phone:980-302-8680
Practice Address - Fax:980-302-8681
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2416363LA2200X
NC5021705363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119371Medicaid
AZZ133891Medicare PIN
AZ119371Medicaid
Q72223Medicare UPIN