Provider Demographics
NPI:1609977016
Name:THOREEN, ELLYN C (ARNP)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:C
Last Name:THOREEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:C
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E. KINCAID ST.
Mailing Address - Street 2:SKAGIT REGIONAL CLINICS
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:3823 - 172ND ST NE
Practice Address - Street 2:CASCADE SKAGIT HEALTH ALLIANCE
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-651-8365
Practice Address - Fax:360-651-8368
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003177363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9609231Medicaid
WAP35446Medicare UPIN
WAAB27278Medicare ID - Type Unspecified