Provider Demographics
NPI:1003913484
Name:PULATIE, ELIZABETH KATHERINE MARY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KATHERINE MARY
Last Name:PULATIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KATHERINE MARY
Other - Last Name:EDDY, ENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:331 E. ENCHANTMENT HEIGHTS DR.
Mailing Address - City:UNION
Mailing Address - State:WA
Mailing Address - Zip Code:98592-0561
Mailing Address - Country:US
Mailing Address - Phone:360-427-9323
Mailing Address - Fax:
Practice Address - Street 1:9040 A REID ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007505367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered