Elizabeth R Otten, PA-C
Physician Assistant in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1881995447
StatusActive
Last updated in NPPESJun 2, 2023
Details
- NPI
- 1881995447
- Entity type
- Individual (NPI-1)
- Name
- Elizabeth R Otten
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 12, 2010
- Certification date
- Jun 2, 2023
- Last updated
- Jun 2, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5601005945 | MI | Yes |
| 363AS0400X | Physician Assistant, Surgical | 5601005945 | MI |
Other names
- Elizabeth R Phillips (Professional Name)
Practice location
3264 N Evergreen Dr NeGrand Rapids, MI 49525-9746
Phone 616-363-7272 · Fax 616-361-5828
Mailing address
3264 N Evergreen Dr NeGrand Rapids, MI 49525-9746
Phone 616-363-7272 · Fax 616-361-5828
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