Individual
CARLIE G. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2709 HEMLOCK ST, BREMERTON, WA 98310-2623
(360) 373-2547
(360) 479-8268
Mailing address
2709 HEMLOCK ST, BREMERTON, WA 98310-2623
(360) 373-2547
(360) 479-8268
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60971061
WA
363LG0600X
Gerontology Nurse Practitioner
Primary
AP60971061
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2138383
—
WA
Enumeration date
07/16/2019
Last updated
11/03/2020
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