Individual
MS. ELLYN ELIZABETH CAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MN, APRN
Contact information
Practice address
4430 106TH ST SW, MUKILTEO, WA 98275-4711
(425) 439-6002
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 258-3900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30002468
WA
363LP0200X
Pediatric Nurse Practitioner
061473-23
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016889
—
VT
05
—
2034048
—
WA
05
—
30347751
—
NH
Enumeration date
10/15/2009
Last updated
11/21/2014
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