Provider Demographics
NPI:1699364380
Name:ELNAS, BABY
Entity Type:Individual
Prefix:
First Name:BABY
Middle Name:
Last Name:ELNAS
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 1:2592 S MERIDIAN APT B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1546
Mailing Address - Country:US
Mailing Address - Phone:850-387-6527
Mailing Address - Fax:
Practice Address - Street 1:2592 S MERIDIAN APT B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1546
Practice Address - Country:US
Practice Address - Phone:850-387-6527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA313250390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program