Provider Demographics
NPI:1487719647
Name:EAKINS, ELLEN M (LMP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:EAKINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11317 NE 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4203
Mailing Address - Country:US
Mailing Address - Phone:360-931-1824
Mailing Address - Fax:
Practice Address - Street 1:10501 NE HIGHWAY 99 STE 23
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5698
Practice Address - Country:US
Practice Address - Phone:360-573-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist