Provider Demographics
NPI:1861152837
Name:SCROGGINS, ELEESA (RN)
Entity type:Individual
Prefix:
First Name:ELEESA
Middle Name:
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 W LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2067
Mailing Address - Country:US
Mailing Address - Phone:509-765-4617
Mailing Address - Fax:
Practice Address - Street 1:1317 W LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2067
Practice Address - Country:US
Practice Address - Phone:509-765-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00103196163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management