MEDICARE: JEANETTE ELLISON 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60449766	WA

General Provider Information

NPI Number	:	1770960858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE ELLISON ARNP

Provider Business Mailing Address
First Line	:	4742 42ND AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4553
Country	:	US
Telephone Number	:	206-200-8598
Fax Number	:

Provider Business Practice Location Address
First Line	:	6957 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1953
Country	:	US
Telephone Number	:	206-935-6228
Fax Number	:	206-932-4856

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

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	04/28/2015

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