Healthcare Provider Details

I. General information

NPI: 1083384978
Provider Name (Legal Business Name): ELINA INYAKINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 08/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 NE 22ND ST
RENTON WA
98059-3855
US

IV. Provider business mailing address

4130 NE 22ND ST
RENTON WA
98059-3855
US

V. Phone/Fax

Practice location:
  • Phone: 425-442-3477
  • Fax:
Mailing address:
  • Phone: 425-442-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number55855
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: