Healthcare Provider Details

I. General information

NPI: 1174098644
Provider Name (Legal Business Name): ELLEN SUMMERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

15035 8TH AVE S
BURIEN WA
98148-1112
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6600
  • Fax: 206-257-6830
Mailing address:
  • Phone: 206-241-3119
  • Fax: 206-241-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00073340
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: