Healthcare Provider Details

I. General information

NPI: 1366902389
Provider Name (Legal Business Name): YELIZAVETA CIOARA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 NE 28TH ST
VANCOUVER WA
98682-8091
US

IV. Provider business mailing address

13501 NE 28TH ST
VANCOUVER WA
98682-8091
US

V. Phone/Fax

Practice location:
  • Phone: 360-604-6825
  • Fax: 360-604-6827
Mailing address:
  • Phone: 360-604-6825
  • Fax: 360-604-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60394606
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: