Provider Demographics
NPI:1790496875
Name:ECKLUND, ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ECKLUND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14527 MOUNTAIN VISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7697
Mailing Address - Country:US
Mailing Address - Phone:253-533-1575
Mailing Address - Fax:
Practice Address - Street 1:14527 MOUNTAIN VISTA DR SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7697
Practice Address - Country:US
Practice Address - Phone:253-533-1575
Practice Address - Fax:253-449-1260
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC615228201041C0700X
WA60671040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse