Healthcare Provider Details

I. General information

NPI: 1013972785
Provider Name (Legal Business Name): ELIZABETH LEE ENGELHARDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902-3761
US

IV. Provider business mailing address

2811 TIETON DR
YAKIMA WA
98902-3761
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8026
  • Fax: 509-577-5061
Mailing address:
  • Phone: 509-575-8026
  • Fax: 509-577-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD00033848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: