Provider Demographics
NPI:1376324210
Name:HA, ELIZABETH JEAN
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:HA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:JEAN
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17825 59TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6453
Mailing Address - Country:US
Mailing Address - Phone:360-363-4234
Mailing Address - Fax:360-363-4235
Practice Address - Street 1:17825 59TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6453
Practice Address - Country:US
Practice Address - Phone:360-363-4234
Practice Address - Fax:363-363-4235
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61479292390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program