Basic Information
| Provider Information | |||||||||
| NPI: | 1417908187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | BOX 359750 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067449888 | ||||||||
| FaxNumber: | 2067449773 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | BOX 359797 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067313000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30002458 | WA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | AP30002458 | WA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0155131 | 01 | WA | L&I | OTHER | 61887U | 01 | WA | REGENCE BLUE SHIELD PIN | OTHER | 9627233 | 05 | WA | MEDICAID |