MEDICARE: ELLA RAE MAIERHOFER RN, ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0400X	Rehabilitation Registered Nurse	RN61093264	WA
2	363L00000X	Nurse Practitioner	AP61464852	WA

General Provider Information

NPI Number	:	1023795978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA RAE MAIERHOFER RN, ARNP

Provider Business Mailing Address
First Line	:	17329 WESTSIDE HWY SW
Second Line	:
City	:	VASHON
State	:	WA
Zip	:	98070-4411
Country	:	US
Telephone Number	:	206-681-6875
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 12TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4411
Country	:	US
Telephone Number	:	206-296-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	05/06/2024

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