MEDICARE: MS. ELAINE ENGOTT CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	460	HI

General Provider Information

NPI Number	:	1477539229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE ENGOTT CRNA

Provider Business Mailing Address
First Line	:	7960 W HIDDEN LAKES DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-9593
Country	:	US
Telephone Number	:	808-783-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	7960 W HIDDEN LAKES DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-9593
Country	:	US
Telephone Number	:	808-783-8348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	01/11/2022

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