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NPI Code Detail

MEDICARE: ELLYNE CARRILLO

MEDICARE: ELLYNE CARRILLO
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
1164X00000XLicensed Vocational Nurse713749CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1713749OTHERCALVN

General Provider Information

NPI Number : 1275486011
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLYNE CARRILLO
Provider Business Mailing Address
First Line : 3285 FERGUSON ST SW STE 218
Second Line :
City : TUMWATER
State : WA
Zip : 98512-6143
Country : US
Telephone Number : 360-943-1907
Fax Number :
Provider Business Practice Location Address
First Line : 3285 FERGUSON ST SW STE 218
Second Line :
City : TUMWATER
State : WA
Zip : 98512-6143
Country : US
Telephone Number : 360-943-1907
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2026
Last Update Date : 02/26/2026

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Directions to “ ELLYNE CARRILLO ” Practice Location

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