Healthcare Provider Details

I. General information

NPI: 1073203089
Provider Name (Legal Business Name): GRACE ELIZABETH VALEN GATROST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 MARKETPLACE DR
NORWALK IA
50211-2338
US

IV. Provider business mailing address

PO BOX 674721
DALLAS TX
75267-4721
US

V. Phone/Fax

Practice location:
  • Phone: 515-974-0800
  • Fax: 515-974-0801
Mailing address:
  • Phone: 515-643-2519
  • Fax: 515-974-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number130443
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: