Provider Demographics
NPI:1154830297
Name:EKLUND, ELIZABETH L (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:EKLUND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22524 MUD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8306
Mailing Address - Country:US
Mailing Address - Phone:616-427-5413
Mailing Address - Fax:
Practice Address - Street 1:1509 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4521
Practice Address - Country:US
Practice Address - Phone:360-603-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61266029163W00000X
CORN.1648414163W00000X
PARN718446163W00000X
COAPN.0993481-CNM367A00000X
PAMW010535367A00000X
WAAP61267015367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse