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NPI Code Detail

MEDICARE: MRS. ELAINE ESTHER DETWILER RN

MEDICARE: MRS. ELAINE ESTHER DETWILER RN
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
1163WR0400XRehabilitation Registered Nurse13-32998-042KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113-32998-042OTHERKSREGISTERED NURSE

General Provider Information

NPI Number : 1083794762
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELAINE ESTHER DETWILER RN
Provider Business Mailing Address
First Line : 6649 SE COUGAR MOUNTAIN WAY
Second Line :
City : BELLEVUE
State : WA
Zip : 98006-5608
Country : US
Telephone Number : 206-277-3312
Fax Number : 206-764-2799
Provider Business Practice Location Address
First Line : 1660 S COLUMBIAN WAY
Second Line : #128
City : SEATTLE
State : WA
Zip : 98108-1532
Country : US
Telephone Number : 206-277-3312
Fax Number : 206-764-2799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 07/08/2007

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