Healthcare Provider Details

I. General information

NPI: 1205302932
Provider Name (Legal Business Name): ELINA KHOVZUN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 10/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

IV. Provider business mailing address

4038 CALIFORNIA AVE SW UNIT B
SEATTLE WA
98116-3708
US

V. Phone/Fax

Practice location:
  • Phone: 206-933-7199
  • Fax:
Mailing address:
  • Phone: 216-410-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60690371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: