Provider Demographics
NPI:1073625547
Name:ARVANETES ELLIS, ESKER (DO)
Entity Type:Individual
Prefix:
First Name:ESKER
Middle Name:
Last Name:ARVANETES ELLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ESKER
Other - Middle Name:M
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:620 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-1108
Mailing Address - Country:US
Mailing Address - Phone:509-877-4111
Mailing Address - Fax:509-877-7349
Practice Address - Street 1:620 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951
Practice Address - Country:US
Practice Address - Phone:509-877-4111
Practice Address - Fax:509-877-7349
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6922207Q00000X
WAOP60541553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine