Provider Demographics
NPI:1275286098
Name:ELIA WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:ELIA WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NDIDIAMAKA
Authorized Official - Middle Name:C JASMINE
Authorized Official - Last Name:NJAKA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:206-800-0593
Mailing Address - Street 1:14205 SE 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1553
Mailing Address - Country:US
Mailing Address - Phone:206-800-0593
Mailing Address - Fax:206-649-0948
Practice Address - Street 1:14205 SE 36TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1553
Practice Address - Country:US
Practice Address - Phone:206-800-0593
Practice Address - Fax:206-649-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty