Provider Demographics
NPI:1235688573
Name:ELLIS, MEREDITH E (ARNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:E
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ARNP, MSN
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:E
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:23525 NE NOVELTY HILL RD STE 111
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-1995
Practice Address - Country:US
Practice Address - Phone:206-320-5190
Practice Address - Fax:206-320-5191
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61451370163W00000X
WAAP61453238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2263308Medicaid