Healthcare Provider Details

I. General information

NPI: 1235102856
Provider Name (Legal Business Name): AMY E ELLINGSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/10/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HOSPITAL WAY
BREWSTER WA
98812
US

IV. Provider business mailing address

415 HOSPITAL WAY
CHELAN WA
98812
US

V. Phone/Fax

Practice location:
  • Phone: 509-668-9374
  • Fax: 509-689-9106
Mailing address:
  • Phone: 509-689-3749
  • Fax: 509-689-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00041306
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: