Provider Demographics
NPI:1316925357
Name:ELLNER, JULIE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:ELLNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 76TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2758
Mailing Address - Country:US
Mailing Address - Phone:206-275-2122
Mailing Address - Fax:206-275-0860
Practice Address - Street 1:2553 76TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2758
Practice Address - Country:US
Practice Address - Phone:206-275-2122
Practice Address - Fax:206-275-0860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD30804208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1082056Medicaid
WAEL0032OtherRIDER NUMBER
WA1082056Medicaid