Basic Information
| Provider Information | |||||||||
| NPI: | 1730664483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAPLAN | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3629 S D ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984186813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536491406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3629 S D ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984186813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536491406 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LP00040779 | WA | N | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 164W00000X | WA | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 101YA0400X- | 05 | WA | MEDICAID |