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General NPI Number Information
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NPI Number | 1821021478
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Entity Type | Individual
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Provider Name | ELLEN L IMSLAND ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 518 E CLAY AVE
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City | CHEWELAH
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State | WA
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Zip | 99109-8947
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Country | US
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Telephone | 509-935-8424
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Fax | 509-935-8402
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Provider Business Mailing Address
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Address Line | 518 E CLAY AVE PO BOX 198
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City | CHEWELAH
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State | WA
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Zip | 99109-8947
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Country | US
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Telephone | 509-935-8424
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Fax | 509-935-8402
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP30007322
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP30007322
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License Number State | WA
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