Healthcare Provider Details

I. General information

NPI: 1609316371
Provider Name (Legal Business Name): ELORA PLISKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELORA JISHRA RN

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date: 08/21/2021
Reactivation Date: 09/14/2021

III. Provider practice location address

11120 NE 33RD PLACE SUITE 202
BELLEVUE WA
98004
US

IV. Provider business mailing address

11120 NE 33RD PL STE 202
BELLEVUE WA
98004-1444
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-1004
  • Fax:
Mailing address:
  • Phone: 206-823-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1112635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: