Provider Demographics
NPI:1518330281
Name:GROSSLIGHT, ERIN (ACNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GROSSLIGHT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:CATHERINE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 1241
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6355
Practice Address - Country:US
Practice Address - Phone:208-381-6930
Practice Address - Fax:208-381-6931
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA955002860363LA2100X
CA95002860363LA2100X
ID67025363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care