Provider Demographics
NPI:1750694014
Name:STORM, ELLEN ROSE (CI/CT NIC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ROSE
Last Name:STORM
Suffix:
Gender:F
Credentials:CI/CT NIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HI-AB-LA PLACE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1701
Mailing Address - Country:US
Mailing Address - Phone:253-732-3508
Mailing Address - Fax:
Practice Address - Street 1:603 HI-AB-LA PLACE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1701
Practice Address - Country:US
Practice Address - Phone:253-732-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter