Provider Demographics
NPI:1912998451
Name:MONSON, ELIZABETH A (CRNP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:MONSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5121 S COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-507-4000
Mailing Address - Fax:801-507-4811
Practice Address - Street 1:3600 NW SAMARITAN DR
Practice Address - Street 2:SUITE E350
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3737
Practice Address - Country:US
Practice Address - Phone:541-768-5205
Practice Address - Fax:541-768-6520
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT270915-4405363LA2200X
OR200950155NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403158000Medicaid
DE1912998451Medicaid
MD622436-01OtherBLUE CROSS/BLUE SHIELD
MDP00348295Medicare PIN
MD622436-01OtherBLUE CROSS/BLUE SHIELD
DE1912998451Medicaid