Healthcare Provider Details

I. General information

NPI: 1235688573
Provider Name (Legal Business Name): MEREDITH E ELLIS ARNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH E DAWSON FNP

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23525 NE NOVELTY HILL RD STE 111
REDMOND WA
98053-1995
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-5190
  • Fax: 206-320-5191
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61453238
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61451370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: