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General NPI Number Information
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NPI Number | 1164957288
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Entity Type | Organization
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Legal Business Name | ELMM CLINIC
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 1500 COMMERCIAL AVE
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City | ANACORTES
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State | WA
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Zip | 98221-2235
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Country | US
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Telephone | 360-399-7732
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Fax | 724-470-8032
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Provider Business Mailing Address
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Address Line | 1500 COMMERCIAL AVE
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City | ANACORTES
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State | WA
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Zip | 98221-2235
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Country | US
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Telephone | 360-399-7732
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Fax | 724-470-8032
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBRA PAGE
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Credential |
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Telephone | 360-420-6474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | MD60251426
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License Number State | WA
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