Provider Demographics
NPI:1508003278
Name:GROSS, ELIZABETH JEAN (50002874)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:GROSS
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Gender:F
Credentials:50002874
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Other - Credentials:
Mailing Address - Street 1:1550 SHERIDAN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1381
Mailing Address - Country:US
Mailing Address - Phone:740-654-0232
Mailing Address - Fax:740-654-9794
Practice Address - Street 1:1550 SHERIDAN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1381
Practice Address - Country:US
Practice Address - Phone:740-654-0232
Practice Address - Fax:740-654-9794
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2010-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50002874363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical