Provider Demographics
NPI:1629320106
Name:ELSETHAGEN, TEHEA KAE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TEHEA
Middle Name:KAE
Last Name:ELSETHAGEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 W 10TH PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1439
Mailing Address - Country:US
Mailing Address - Phone:509-783-5343
Mailing Address - Fax:
Practice Address - Street 1:10121 W CLEARWATER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3500
Practice Address - Country:US
Practice Address - Phone:509-783-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60309318364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health