Basic Information
| Provider Information | |||||||||
| NPI: | 1023564358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEWHA | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY EMERGENCY MEDICINE FOUNDATION | ||||||||
| Address2: | 125 WHIPPLE STREET 3RD FLOOR | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029083258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018542504 | ||||||||
| FaxNumber: | 4014277795 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY STREET | ||||||||
| Address2: | CLAVERICK 2 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014445451 | ||||||||
| FaxNumber: | 4014445922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA00885 | RI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.