Provider Demographics
NPI:1649394313
Name:ELLIS, DONALD LANCE (DONALD ELLIS LMP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LANCE
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DONALD ELLIS LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3650
Mailing Address - Country:US
Mailing Address - Phone:425-355-7539
Mailing Address - Fax:425-290-6936
Practice Address - Street 1:2610 B COLBY AVE.
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-870-1547
Practice Address - Fax:425-290-6936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist