Individual
ELLYNE CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3285 FERGUSON ST SW STE 218, TUMWATER, WA 98512-6143
(360) 943-1907
Mailing address
3285 FERGUSON ST SW STE 218, TUMWATER, WA 98512-6143
(360) 943-1907
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
713749
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
713749
LVN
CA
Enumeration date
02/19/2026
Last updated
02/26/2026
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