Individual
ELLEN DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3927 RUCKER AVE, EVERETT, WA 98201-4833
(425) 339-5422
(425) 339-5444
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 339-5422
(425) 339-5444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
14042
NV
207Q00000X
Family Medicine Physician
Primary
MD00024413
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639167638
—
NV
05
—
2055678
—
WA
01
—
P01332614
RR MEDICARE
NV
Enumeration date
10/12/2005
Last updated
04/14/2021
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