Healthcare Provider Details

I. General information

NPI: 1992189567
Provider Name (Legal Business Name): ELIZABETH ANN SKELLY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN CHASE ARNP

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY STE 300
SEATTLE WA
98122-5391
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-9071
  • Fax: 206-710-9016
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP61206090
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60929557
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: