Individual
MS. ELLEN AUGUSTINE JACUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
77 N MAIN ST, COUPEVILLE, WA 98239-9556
(360) 678-4440
Mailing address
PO BOX 746, COUPEVILLE, WA 98239-0746
(360) 678-4440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10005023
WA
363AM0700X
Medical Physician Assistant
PA10005023
WA
Other
Enumeration date
06/09/2006
Last updated
05/09/2011
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