Basic Information
| Provider Information | |||||||||
| NPI: | 1184799074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16110 8TH AVE SW | ||||||||
| Address2: | SUITE A-2 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981662962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062428280 | ||||||||
| FaxNumber: | 2062428302 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 N 10TH ST UNIT 304 | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334115469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30005689 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 9642604 | 05 | WA | MEDICAID |