Provider Demographics
NPI:1548890270
Name:REALE, ELIZABETH KATE (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATE
Last Name:REALE
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 1:361 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4558
Mailing Address - Country:US
Mailing Address - Phone:413-426-4332
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3160
Practice Address - Country:US
Practice Address - Phone:413-586-8910
Practice Address - Fax:413-584-7270
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant