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General NPI Number Information
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NPI Number | 1649291196
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Entity Type | Individual
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Provider Name | ALLAN J. ELLSWORTH PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC ST
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City | SEATTLE
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State | WA
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Zip | 98195-0001
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Country | US
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Telephone | 206-598-5618
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Fax | 206-598-5720
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Provider Business Mailing Address
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Address Line | PO BOX 24366
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City | SEATTLE
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State | WA
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Zip | 98124-0366
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Country | US
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Telephone | 206-598-0502
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Fax | 206-598-0516
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PA10004406
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License Number State | WA
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