Provider Demographics
NPI:1255375192
Name:DICK, ELIZABETH A (ARNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DICK
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 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-473-0637
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:1100 GOETHALS DR STE E
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3301
Practice Address - Country:US
Practice Address - Phone:509-942-3095
Practice Address - Fax:509-942-3097
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57927207P00000X
NC5018691363L00000X
OHNP-05417363LA2100X
WAAP61278967363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2888157Medicaid
OH000000592451OtherANTHEM
OHP00719631OtherRRMCR
OH000000699820OtherANTHEM
OHP00719631OtherRRMCR
WVS94258Medicare UPIN
OH000000592451OtherANTHEM
OHNP28881Medicare PIN