Provider Demographics
NPI:1104048180
Name:GOLDEN, ELISABETH B (ARNP)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:B
Last Name:GOLDEN
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 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:27500 168TH PL SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5563
Practice Address - Country:US
Practice Address - Phone:425-690-3430
Practice Address - Fax:425-690-9430
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007549363L00000X
WARN00161090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1002411Medicaid
WAG8891523OtherMEDICARE - VALLEY MEDICAL GROUP
WAG8865818Medicare PIN
WAG8865814Medicare PIN
WAG8865813Medicare PIN
WAG8865185Medicare PIN
WAG8865812Medicare PIN
WAG8865816Medicare PIN