Healthcare Provider Details

I. General information

NPI: 1083794762
Provider Name (Legal Business Name): ELAINE ESTHER DETWILER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY #128
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

6649 SE COUGAR MOUNTAIN WAY
BELLEVUE WA
98006-5608
US

V. Phone/Fax

Practice location:
  • Phone: 206-277-3312
  • Fax: 206-764-2799
Mailing address:
  • Phone: 206-277-3312
  • Fax: 206-764-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number13-32998-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: