Provider Demographics
NPI:1801317946
Name:ELLISOR, REBECCA (CD CHT BHE)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:ELLISOR
Suffix:
Gender:F
Credentials:CD CHT BHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:WA
Mailing Address - Zip Code:98576-0892
Mailing Address - Country:US
Mailing Address - Phone:360-481-0299
Mailing Address - Fax:
Practice Address - Street 1:13207 SQUAWWOOD LN SE
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:WA
Practice Address - Zip Code:98576-9638
Practice Address - Country:US
Practice Address - Phone:360-481-0299
Practice Address - Fax:360-481-0299
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula