Provider Demographics
NPI:1437486727
Name:ELLERBROOK, DIONNE ELAINE (LPN)
Entity type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:ELAINE
Last Name:ELLERBROOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 NW 28TH LOOP
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7212
Mailing Address - Country:US
Mailing Address - Phone:503-740-0100
Mailing Address - Fax:
Practice Address - Street 1:3025 SW RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9481
Practice Address - Country:US
Practice Address - Phone:541-548-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200830485LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse