Healthcare Provider Details

I. General information

NPI: 1922339357
Provider Name (Legal Business Name): ELIZABETH ROSE CREASY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10407 TIETON DR
YAKIMA WA
98908-9591
US

IV. Provider business mailing address

10407 TIETON DR
YAKIMA WA
98908-9591
US

V. Phone/Fax

Practice location:
  • Phone: 509-731-4908
  • Fax:
Mailing address:
  • Phone: 509-731-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60124572
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN60124572
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60124572
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: