Healthcare Provider Details

I. General information

NPI: 1821021478
Provider Name (Legal Business Name): ELLEN L IMSLAND ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 E CLAY AVE
CHEWELAH WA
99109-8947
US

IV. Provider business mailing address

518 E CLAY AVE PO BOX 198
CHEWELAH WA
99109-8947
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-8424
  • Fax: 509-935-8402
Mailing address:
  • Phone: 509-935-8424
  • Fax: 509-935-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007322
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP30007322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: