Provider Demographics
NPI:1457239139
Name:BABCOCK, ELIZABETH ALINE (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALINE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 E BURMA RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ID
Mailing Address - Zip Code:83833-7777
Mailing Address - Country:US
Mailing Address - Phone:509-301-4623
Mailing Address - Fax:
Practice Address - Street 1:893 E BURMA RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:ID
Practice Address - Zip Code:83833-7777
Practice Address - Country:US
Practice Address - Phone:509-301-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant