DR. KATHLEEN ELOISE ELLSTROM (NPI# 1023023728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023023728 |
| Entity Type | Individual |
| Full Name | DR. KATHLEEN ELOISE ELLSTROM |
| Credential | PHD, RN, APRN,BC |
| Practice Address |
11201 Benton St 111p Loma Linda CA 92357-1000 |
| Mailing Address |
22595 Cardinal St Grand Terrace CA 92313-5732 |
| Practice Telephone | 9095836095 |
| Practice Fax Number | 9097773214 |
| Mailing Telephone | 9097830594 |
| Mailing Fax Number | 9097836714 |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SM0705X |
Clinical Nurse Specialist Specialization: Medical-Surgical |
539 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11201 BENTON ST 111P |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92357-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841290558 | Russell Evan Hoxie Jr. | Internal Medicine | 11201 Benton St, Loma Linda, CA 92357-1000 | 2005-07-22 |
| 1104435643 | Megan Satre | Audiologist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-07-30 |
| 1972111862 | Aileen Nati Ludesirishoti | Pharmacist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-07-17 |
| 1649894551 | Bryan Lamont Brewer | Social Worker | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-06-05 |
| 1518580497 | Nicole Kaye Whittle | Audiologist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-05-26 |
| 1629690375 | Kevin Alan Cox | Student in an Organized Health Care Education/Training Program | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-05-15 |
| 1033731443 | Joni Lynn Stanton | Registered Nurse | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-05-08 |
| 1134748536 | Abednego Tamba | Registered Nurse | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-04-15 |
| 1447885884 | Zachary Michael Cruz | Registered Nurse | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-03-05 |
| 1972141695 | Tanya Lengvilas | Pharmacist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2019-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679916027 | Nicole Kristine Shah-ghassemzadeh | Internal Medicine | Jerry L. Pettis Memorial Veterans Hospital - Gastroente, 11201 Benton Street, Loma Linda, CA 92357 | 2013-04-16 |
| 1760628598 | Taranjit Natt | Internal Medicine | 11201 Benton St # 111-om, Loma Linda, CA 92357 | 2008-12-29 |
| 1548355076 | Annette A Boyd -hampton | Nurse Practitioner | 11201 Benton St. -111g, Loma Linda, CA 92357 | 2006-10-03 |
| 1396830766 | Maudie Cantrell Foy | Nurse Practitioner | 11201 Benton St. (11cp), Loma Linda, CA 92357 | 2006-10-03 |
| 1427154715 | Kenneth Wong | Pharmacist | 11201 Benton St. (119), Loma Linda, CA 92357 | 2006-09-15 |
| 1801909577 | Paul Lindberg | Orthotist | 11201 Benton St./121, Loma Linda, CA 92357 | 2006-08-16 |
| 1992728703 | Harry Chen | Pharmacist | 11201 Benton Street, Va Loma Linda Healthcare System (119), Loma Linda, CA 92357 | 2006-07-25 |
| 1699222661 | Nathanial Benjaman Hawkins | Psychologist | 11201 Benton Street, Bhost 116a, Loma Linda, CA 92357 | 2016-09-07 |
| 1063877959 | Irene Thung | Pathology | 11201 Benton Street, Dept. of Pathology (113), Loma Linda, CA 92357 | 2015-12-21 |
| 1033553375 | Brian Chau | Physical Medicine & Rehabilitation | 11201 Benton Street, Department of Pm&r (mail Code 117), Loma Linda, CA 92357 | 2013-04-17 |
| Find all providers in zip 92357 | ||||
| Taxonomy Code | 364SM0705X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Medical-Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780959155 | Ivonne T. Jorif | Clinical Nurse Specialist | 3632 Kalsman Dr, #3, Los Angeles, CA 90016-4416 | 2012-03-18 |
| 1356461180 | Julie Binion | Clinical Nurse Specialist | 522 W Omaha Ave, Clovis, CA 93619-4805 | 2007-03-29 |
| 1023146016 | Susan Scott Zoellner | Clinical Nurse Specialist | 240 Harding Ave, Los Gatos, CA 95030-6307 | 2007-03-01 |
| 1073669495 | Gary M Fuller | Clinical Nurse Specialist | 351 Hearst Ave, San Francisco, CA 94112-1348 | 2007-01-26 |
| 1710205158 | Fatima Ascano-martin | Clinical Nurse Specialist | 375 Laguna Honda Blvd, San Francisco, CA 94116-1411 | 2010-05-10 |
| 1659699106 | Diane Barbara Vaccaro | Clinical Nurse Specialist | 375 Laguna Honda Blvd, San Francisco, CA 94116-1411 | 2010-05-07 |
| 1639492895 | Yasmin Cecile Embden | Clinical Nurse Specialist | 2701 W Alameda Ave, Suite 602, Burbank, CA 91505-4402 | 2010-03-02 |
| 1164673430 | Sabine Foster | Clinical Nurse Specialist | 2801 Atlantic Ave, Long Beach, CA 90806-1701 | 2008-10-06 |
| 1083876551 | Regina Marie Singh | Clinical Nurse Specialist | 1401 Spanos Ct, Suite 103, Modesto, CA 95355-2810 | 2008-06-26 |
| 1811046790 | Donna G Patey | Clinical Nurse Specialist | 975 Sereno Dr, Vallejo, CA 94589-2441 | 2007-01-09 |
| Find all providers with the same taxonomy | ||||
| City | LOMA LINDA |
| Zip Code | 92357 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.