=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396273009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YELENA I VERBITSKAYA PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2017
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3927 RUCKER AVE BLDG ENT
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98201-4833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-339-5441
-----------------------------------------------------
Fax | 425-259-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5127
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98206-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-860-5414
-----------------------------------------------------
Fax | 206-720-8462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA60774310
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------