Provider Demographics
NPI:1467498550
Name:GROMOFSKY, ELAINE E (CRNA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:E
Last Name:GROMOFSKY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:SUTTER CREEK OB ANESTHESIA
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685
Mailing Address - Country:US
Mailing Address - Phone:888-270-0340
Mailing Address - Fax:888-270-0331
Practice Address - Street 1:7500 TIMBERLAKE
Practice Address - Street 2:METHODIST HOSPITAL 2ND FLOOR LABOR AND DELIVERY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-423-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447350163W00000X
CA1506367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN447350Medicaid
P27567Medicare UPIN