Provider Demographics
NPI:1083794762
Name:DETWILER, ELAINE ESTHER (RN)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ESTHER
Last Name:DETWILER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6649 SE COUGAR MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5608
Mailing Address - Country:US
Mailing Address - Phone:206-277-3312
Mailing Address - Fax:206-764-2799
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:#128
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-3312
Practice Address - Fax:206-764-2799
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-32998-042163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS13-32998-042OtherREGISTERED NURSE