Provider Demographics
NPI:1093040412
Name:PANUTICH, ELENA A (PHD, ND)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:A
Last Name:PANUTICH
Suffix:
Gender:F
Credentials:PHD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 NE 129TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3273
Mailing Address - Country:US
Mailing Address - Phone:360-718-8949
Mailing Address - Fax:360-852-8194
Practice Address - Street 1:2105 NE 129TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3273
Practice Address - Country:US
Practice Address - Phone:360-718-8949
Practice Address - Fax:360-852-8194
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1696175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath