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General NPI Number Information
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NPI Number | 1881480093
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Entity Type | Individual
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Provider Name | ELLISA ESTHER LPN
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1412 SW 43RD ST STE 140
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 503-616-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 10622 SE 252ND ST UNIT G309
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City | KENT
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State | WA
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Zip | 98030-9058
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Country | US
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Telephone | 503-616-8330
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP61475162
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License Number State | WA
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