Provider Demographics
NPI:1336876747
Name:DONNA ELAM PLLC
Entity Type:Organization
Organization Name:DONNA ELAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-561-3098
Mailing Address - Street 1:3118 BANKS LN SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-1451
Mailing Address - Country:US
Mailing Address - Phone:360-561-3098
Mailing Address - Fax:
Practice Address - Street 1:222 KENYON ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4573
Practice Address - Country:US
Practice Address - Phone:313-719-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty