Provider Demographics
NPI:1003249442
Name:CROSS, ELIZABETH LYNNE (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LYNNE
Last Name:CROSS
Suffix:
Gender:F
Credentials:AGNP-C
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Mailing Address - Street 1:1310 WISCONSIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2472
Mailing Address - Country:US
Mailing Address - Phone:616-844-4528
Mailing Address - Fax:
Practice Address - Street 1:1310 WISCONSIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2472
Practice Address - Country:US
Practice Address - Phone:616-844-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704253344363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology