Healthcare Provider Details

I. General information

NPI: 1760692198
Provider Name (Legal Business Name): ELISE JENSEN SIMONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISE MARIE JENSEN

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N 115TH ST STE 101
SEATTLE WA
98133-8414
US

IV. Provider business mailing address

1560 N 115TH ST STE 101
SEATTLE WA
98133-8414
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-6806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA116465
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD.MD.60664422
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: