Provider Demographics
NPI:1003947300
Name:JEANNE ELLIOTT NP PS
Entity Type:Organization
Organization Name:JEANNE ELLIOTT NP PS
Other - Org Name:AFFORDABLE HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:NP PS
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-537-8802
Mailing Address - Street 1:2555 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-3930
Mailing Address - Country:US
Mailing Address - Phone:360-537-8802
Mailing Address - Fax:310-634-1706
Practice Address - Street 1:2555 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3930
Practice Address - Country:US
Practice Address - Phone:360-537-8802
Practice Address - Fax:310-634-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007337261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care