Healthcare Provider Details

I. General information

NPI: 1750694014
Provider Name (Legal Business Name): ELLEN ROSE STORM CI/CT NIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HI-AB-LA PLACE NE
TACOMA WA
98422-1701
US

IV. Provider business mailing address

603 HI-AB-LA PLACE NE
TACOMA WA
98422-1701
US

V. Phone/Fax

Practice location:
  • Phone: 253-732-3508
  • Fax:
Mailing address:
  • Phone: 253-732-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: