Provider Demographics
NPI:1851313134
Name:ELLINGSON-MILLER, ROBIN GRACE (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:GRACE
Last Name:ELLINGSON-MILLER
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 1:3610 ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5025
Mailing Address - Country:US
Mailing Address - Phone:360-493-5252
Mailing Address - Fax:360-493-5257
Practice Address - Street 1:3610 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5025
Practice Address - Country:US
Practice Address - Phone:360-493-5252
Practice Address - Fax:360-493-5257
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB37398Medicare ID - Type Unspecified
WAP92073Medicare UPIN