Provider Demographics
NPI:1548443310
Name:ELOWE, AN S (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AN
Middle Name:S
Last Name:ELOWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AN
Other - Middle Name:S
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:506 W VALLEY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-5716
Mailing Address - Country:US
Mailing Address - Phone:626-308-3800
Mailing Address - Fax:626-308-1899
Practice Address - Street 1:506 W VALLEY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-5716
Practice Address - Country:US
Practice Address - Phone:626-308-3800
Practice Address - Fax:626-308-1899
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053026363A00000X
MI5601005427363AM0700X
CA53049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232664784OtherGROUP TAX ID