Provider Demographics
NPI:1538354840
Name:NANCE, ELISE (PA-C)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:NANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:PAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5725 W LAS POSITAS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4054
Mailing Address - Country:US
Mailing Address - Phone:925-469-6274
Mailing Address - Fax:
Practice Address - Street 1:5725 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4054
Practice Address - Country:US
Practice Address - Phone:925-469-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19238363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PA192380Medicare PIN