Healthcare Provider Details

I. General information

NPI: 1457177339
Provider Name (Legal Business Name): ELLIE ADRIANA KOW DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 164TH AVE NE STE A215
REDMOND WA
98052-7809
US

IV. Provider business mailing address

2475 140TH AVE NE FL 1
BELLEVUE WA
98005-1892
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-9292
  • Fax: 425-885-9106
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61598091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: