Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MD00038997 | WA |
NPI | 1235125220 |
---|---|
Provider Name | Elizabeth Ann Grosen |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010143078 | BLUE SHIELD OF IDAHO (01) | WA |
0161841 | LABOR & INDUSTRIES (01) | WA |
4664303 | AETNA (01) | |
805800300 | (05) | ID |
8257594 | (05) | WA |
8340GR | ASURIS NW HEALTH (01) | WA |
980000405 | RAILROAD MEDICARE (01) | |
E72953 | (02) | |
KR819 | BLUE CROSS OF IDAHO (01) | WA |