Provider Demographics
NPI:1548845779
Name:ELLIOTT, HEIDI DAWN
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:DAWN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 BROWNS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2308
Mailing Address - Country:US
Mailing Address - Phone:253-202-3495
Mailing Address - Fax:253-944-1320
Practice Address - Street 1:1420 3RD ST SE STE 106
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3730
Practice Address - Country:US
Practice Address - Phone:253-202-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00157846163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy