Kathleen Eloise Ellstrom, PHD, RN, APRN,BC

Primary specialty

Medical-Surgical Clinical Nurse SpecialistTaxonomy code 364SM0705X

License

539 Issued in CA

Practice address

11201 Benton St
111P
Loma Linda, CA 92357-1000

Phone

(909) 583-6095

Fax

(909) 777-3214

NPI assigned

Jul 30, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023023728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22595 CARDINAL ST",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135732",
            "telephone_number": "909-783-0594",
            "fax_number": "909-783-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "address_2": "111P",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923571000",
            "telephone_number": "909-583-6095",
            "fax_number": "909-777-3214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSTROM",
        "first_name": "KATHLEEN",
        "middle_name": "ELOISE",
        "name_prefix": "Dr.",
        "credential": "PHD, RN, APRN,BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SM0705X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Medical-Surgical",
            "state": "CA",
            "license": "539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waleed Eliwat, DO
• Mary Wafik Megaly Elkomos
• Deborah R Ellis, RN NP
• Kaelan Patrick Ellis, DPT
• Joshua Dean Elloway, PT
• Meriel Elmalih, PHARMD
• Edward N Elmendorf III, M.D.
• Feryal Elorr, MD
• Nesreen Elsaadi, MD
• Ashley Elsensohn, MD

• Medical-Surgical Clinical Nurse Specialist in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Medical-Surgical Clinical Nurse Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.