Provider Demographics
NPI:1033685839
Name:HEGENAUER, ELLEN CHARITY SUMOGUE (RN)
Entity type:Individual
Prefix:
First Name:ELLEN CHARITY
Middle Name:SUMOGUE
Last Name:HEGENAUER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:S
Other - Last Name:HEGENAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 5TH AVENUE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1818
Mailing Address - Country:US
Mailing Address - Phone:206-263-8414
Mailing Address - Fax:206-205-7375
Practice Address - Street 1:33431 13TH PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6357
Practice Address - Country:US
Practice Address - Phone:206-263-6741
Practice Address - Fax:206-296-8412
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60612137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse