Healthcare Provider Details

I. General information

NPI: 1073422812
Provider Name (Legal Business Name): LARAH ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SE 36TH ST STE 205
MERCER ISLAND WA
98040-3840
US

IV. Provider business mailing address

7626 40TH ST W APT 13
UNIVERSITY PLACE WA
98466-3804
US

V. Phone/Fax

Practice location:
  • Phone: 425-553-2747
  • Fax:
Mailing address:
  • Phone: 800-925-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN60978210
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: