Provider Demographics
NPI:1144652348
Name:INDORF, ELIZABETH CHRISTINA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CHRISTINA
Last Name:INDORF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NEW BRITAIN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3167
Mailing Address - Country:US
Mailing Address - Phone:860-224-9879
Mailing Address - Fax:
Practice Address - Street 1:211 NEW BRITAIN RD STE 105
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-3167
Practice Address - Country:US
Practice Address - Phone:860-224-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant