Provider Demographics
NPI:1821021478
Name:IMSLAND, ELLEN L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:L
Last Name:IMSLAND
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 1:518 E CLAY AVE
Mailing Address - Street 2:PO BOX 198
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-8947
Mailing Address - Country:US
Mailing Address - Phone:509-935-8424
Mailing Address - Fax:509-935-8402
Practice Address - Street 1:518 E CLAY AVE
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-8947
Practice Address - Country:US
Practice Address - Phone:509-935-8424
Practice Address - Fax:509-935-8402
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007322363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACE9078OtherRAILROAD MEDICARE
WA0210113OtherLABOR & INDUSTRIES ID NO.