Basic Information
| Provider Information | |||||||||
| NPI: | 1982933792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14402 E SPRAGUE AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099222625 | ||||||||
| FaxNumber: | 5099224001 | ||||||||
| Practice Location | |||||||||
| Address1: | 14402 E SPRAGUE AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099222625 | ||||||||
| FaxNumber: | 5099224001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60112017 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 2004317 | 05 | WA | MEDICAID |