Provider Demographics
NPI:1871781963
Name:COUTURE, ELIZABETH ANN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
Last Name:COUTURE
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 1:5570 DTC PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3189
Mailing Address - Country:US
Mailing Address - Phone:303-925-4960
Mailing Address - Fax:
Practice Address - Street 1:5570 DTC PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-925-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104170363A00000X
COPA 0004096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24851850Medicaid
CO386709YKRDMedicare Oscar/Certification