Individual
MS. ELLEN M HANISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
11511 CANTERWOOD BLVD, SUITE 45, GIG HARBOR, WA 98332-5813
(253) 858-4725
(253) 858-4452
Mailing address
1624 SOUTH I STREET, SUITE 305, TACOMA, WA 98405-5093
(253) 428-8700
(253) 383-3376
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
110748
NE
363L00000X
Nurse Practitioner
A-108210
IA
363L00000X
Nurse Practitioner
Primary
AP60134362
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0421586
—
IA
01
—
33314
WELLMARK
IA
Enumeration date
07/09/2005
Last updated
08/01/2012
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