Provider Demographics
NPI:1659497873
Name:SCHUPAY, ELLEN JANE (RN, ARNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JANE
Last Name:SCHUPAY
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:JANE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3390
Mailing Address - Country:US
Mailing Address - Phone:360-434-3607
Mailing Address - Fax:
Practice Address - Street 1:2001 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2959
Practice Address - Country:US
Practice Address - Phone:206-935-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006602363LW0102X
CARN460884-5524363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health