Provider Demographics
NPI:1083381487
Name:ELLERMEIER, DEBORAH LYNN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:ELLERMEIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2038
Mailing Address - Country:US
Mailing Address - Phone:206-406-9884
Mailing Address - Fax:
Practice Address - Street 1:10702 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2038
Practice Address - Country:US
Practice Address - Phone:206-406-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60852031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWDL3BSZ6933BMedicaid