Healthcare Provider Details

I. General information

NPI: 1891802146
Provider Name (Legal Business Name): LIISA ELINA DURCHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELINA DURCHMAN M.D.

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10634 E RIVERSIDE DR STE 130
BOTHELL WA
98011-3758
US

IV. Provider business mailing address

509 3RD ST
MUKILTEO WA
98275-1551
US

V. Phone/Fax

Practice location:
  • Phone: 206-934-9110
  • Fax: 844-961-0333
Mailing address:
  • Phone: 206-484-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD60000894
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60000894
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: