Provider Demographics
NPI:1043613409
Name:BURNETT, ELENA MOYLE (MS)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MOYLE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 SW BOND AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4596
Mailing Address - Country:US
Mailing Address - Phone:775-378-5701
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-418-4207
Practice Address - Fax:503-494-2759
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen