Provider Demographics
NPI:1558046904
Name:SPERRY, ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:SPERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21851 84TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1958
Mailing Address - Country:US
Mailing Address - Phone:425-687-7082
Mailing Address - Fax:
Practice Address - Street 1:21851 84TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1958
Practice Address - Country:US
Practice Address - Phone:425-687-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00040323164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse