Healthcare Provider Details

I. General information

NPI: 1891840310
Provider Name (Legal Business Name): ELENA C MEJIA FNP, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MAIN ST STE 202
WALLA WALLA WA
99362-2872
US

IV. Provider business mailing address

3316 SE STEPHENS ST
PORTLAND OR
97214-5055
US

V. Phone/Fax

Practice location:
  • Phone: 509-526-6944
  • Fax:
Mailing address:
  • Phone: 503-740-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number156530
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60404698
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60403410
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number093006358N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: