Healthcare Provider Details

I. General information

NPI: 1033685839
Provider Name (Legal Business Name): ELLEN CHARITY SUMOGUE HEGENAUER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN S HEGENAUER

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33431 13TH PL S
FEDERAL WAY WA
98003-6357
US

IV. Provider business mailing address

401 5TH AVENUE SUITE 1000
SEATTLE WA
98104-1818
US

V. Phone/Fax

Practice location:
  • Phone: 206-263-6741
  • Fax: 206-296-8412
Mailing address:
  • Phone: 206-263-8414
  • Fax: 206-205-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60612137
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: