Provider Demographics
NPI:1235125220
Name:GROSEN, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:GROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:WYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-2200
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:101 W 8TH AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-2200
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038997207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000010143078OtherBLUE SHIELD OF IDAHO
WA8257594Medicaid
980000405OtherRAILROAD MEDICARE
4664303OtherAETNA
ID805800300Medicaid
WAKR819OtherBLUE CROSS OF IDAHO
WA8340GROtherASURIS NW HEALTH
WA0161841OtherLABOR & INDUSTRIES
WAKR819OtherBLUE CROSS OF IDAHO
WA8340GROtherASURIS NW HEALTH