Provider Demographics
NPI:1104135870
Name:ELENBAAS, ALLAN (RN,CNOR,CRNFA)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:ELENBAAS
Suffix:
Gender:M
Credentials:RN,CNOR,CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9451
Mailing Address - Country:US
Mailing Address - Phone:206-368-6360
Mailing Address - Fax:206-368-6361
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 270
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-368-6360
Practice Address - Fax:206-368-6361
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00055805163W00000X
WA080904364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
No163W00000XNursing Service ProvidersRegistered Nurse