Active NPI
Ellyn Elizabeth Cavanagh, PHD, MN, APRN
- Nurse Practitioner
- Mukilteo, WA
National Provider Identifier
1669707287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP30002468
- Practice address
- 4430 106TH St SW
Mukilteo, WA 98275-4711 - Phone
- (425) 439-6002
- NPI assigned
- Oct 15, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP30002468 | WA | Primary |
| Pediatric Nurse Practitioner | 363LP0200X | 061473-23 | NH |
Addresses
Primary practice location
4430 106TH St SW
Mukilteo, WA 98275-4711
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3900
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2034048 | Medicaid | WA | |
| 30347751 | Medicaid | NH | |
| 1016889 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061473-23 | NH | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Care Washington PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Everett, WA
- NPI 1154318103
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416528000000",
"number": "1669707287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127",
"telephone_number": "425-258-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4430 106TH ST SW",
"city": "MUKILTEO",
"state": "WA",
"postal_code": "982754711",
"telephone_number": "425-439-6002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVANAGH",
"first_name": "ELLYN",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "PHD, MN, APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-15",
"last_updated": "2014-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP30002468",
"primary": true
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "NH",
"license": "061473-23",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2034048",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30347751",
"state": "NH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1016889",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mukilteo, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.