Provider Demographics
NPI:1164842779
Name:ELPERIN, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ELPERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2473
Mailing Address - Country:US
Mailing Address - Phone:509-452-4520
Mailing Address - Fax:509-452-5224
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3609
Practice Address - Country:US
Practice Address - Phone:509-424-5899
Practice Address - Fax:509-651-9971
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60576478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035962Medicaid