Provider Demographics
NPI:1881787596
Name:BOSQUE, ELENA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:BOSQUE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:GATENBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-0430
Mailing Address - Country:US
Mailing Address - Phone:425-656-5525
Mailing Address - Fax:425-656-4228
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-656-5525
Practice Address - Fax:425-656-4228
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005076363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9626383Medicaid
WAAB34132Medicare ID - Type Unspecified
WA9626383Medicaid