Provider Demographics
NPI:1750159380
Name:CALICDAN, ELLA MAE
Entity type:Individual
Prefix:
First Name:ELLA MAE
Middle Name:
Last Name:CALICDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 32ND ST NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2910
Mailing Address - Country:US
Mailing Address - Phone:206-376-8646
Mailing Address - Fax:
Practice Address - Street 1:4921 32ND ST NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-2910
Practice Address - Country:US
Practice Address - Phone:206-376-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60906418376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide