Provider Demographics
NPI:1609601996
Name:PRAIRIE, ELLEN STEPHEN (ND)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:STEPHEN
Last Name:PRAIRIE
Suffix:
Gender:U
Credentials:ND
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:PRAIRIE
Other - Last Name:GORSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:3325 BURKE AVE N UNIT 422
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9192
Mailing Address - Country:US
Mailing Address - Phone:612-481-6383
Mailing Address - Fax:
Practice Address - Street 1:3325 BURKE AVE N UNIT 422
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9192
Practice Address - Country:US
Practice Address - Phone:612-481-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath