Provider Demographics
NPI:1477539229
Name:ENGOTT, ELAINE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:ENGOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:7960 W HIDDEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9593
Mailing Address - Country:US
Mailing Address - Phone:808-783-8348
Mailing Address - Fax:
Practice Address - Street 1:7960 W HIDDEN LAKES DR
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-9593
Practice Address - Country:US
Practice Address - Phone:808-783-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI460367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered