Provider Demographics
NPI:1508937004
Name:GROSE, ELIZABETH A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:GROSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 FRUITVALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1465
Mailing Address - Country:US
Mailing Address - Phone:509-966-0199
Mailing Address - Fax:509-966-4266
Practice Address - Street 1:717 FRUITVALE BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1465
Practice Address - Country:US
Practice Address - Phone:509-966-0199
Practice Address - Fax:509-966-4266
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006768363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8943771OtherCRIME VICTIMS
WA9066GROtherREGENCE
WA0194525OtherLABOR AND INDUSTRIES
WA9645060Medicaid
WA8943771OtherCRIME VICTIMS
WAQ43670Medicare UPIN
WA9645060Medicaid