Provider Demographics
NPI:1043412018
Name:HART, ELLA M (RN, BSN, MN)
Entity Type:Individual
Prefix:MS
First Name:ELLA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:RN, BSN, MN
Other - Prefix:MS
Other - First Name:ELLA
Other - Middle Name:H
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:12924 SE 228TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3647
Mailing Address - Country:US
Mailing Address - Phone:206-251-1296
Mailing Address - Fax:
Practice Address - Street 1:516 176TH ST E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8335
Practice Address - Country:US
Practice Address - Phone:206-251-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00062055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9602020Medicaid
WAS69946Medicare UPIN
WA9602020Medicaid