Healthcare Provider Details

I. General information

NPI: 1265060545
Provider Name (Legal Business Name): ERIN ELIZABETH ELLISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN ELIZABETH HUNT

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 GEORGIANA ST
PORT ANGELES WA
98362-3911
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-0999
  • Fax: 360-565-9251
Mailing address:
  • Phone: 360-565-0999
  • Fax: 360-565-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD70013649
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: