Provider Demographics
NPI:1518680586
Name:UDTOHAN, ELIENHEL JOY G (LP61213828)
Entity Type:Individual
Prefix:
First Name:ELIENHEL JOY
Middle Name:G
Last Name:UDTOHAN
Suffix:
Gender:F
Credentials:LP61213828
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15448 NE 13TH PL APT 1506
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7542
Mailing Address - Country:US
Mailing Address - Phone:425-274-5907
Mailing Address - Fax:
Practice Address - Street 1:1412 140TH PL NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3915
Practice Address - Country:US
Practice Address - Phone:747-789-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61213828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse