Healthcare Provider Details

I. General information

NPI: 1437609567
Provider Name (Legal Business Name): ELINA BARANETS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14204 NE SALMON CREEK AVENUE
VANCOUVER WA
98686
US

IV. Provider business mailing address

18 NW 20TH AVE STE 101
BATTLE GROUND WA
98604-4175
US

V. Phone/Fax

Practice location:
  • Phone: 360-241-4475
  • Fax:
Mailing address:
  • Phone: 360-241-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60127608
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN60127608
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60910474
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: