| Doctor Name: | DR. KATHLEEN ELOISE ELLSTROM |
| NPI Number: | 1023023728 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, RN, APRN,BC |
| License Number: | 539 |
| Business Practice Address: | 11201 Benton St 111p Loma Linda, CA - 923571000 |
| Business Phone Number: | 9095836095 |
| Business Fax Number: | 9097773214 |
| Mailing Address: | 22595 Cardinal St, GRAND TERRACE |
| State: | CA |
| Postal Code: | 923135732 |
| Phone Number: | 9097830594 |
| Fax Number: | 9097836714 |
| NPI Enumeration Date: | 07/30/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SM0705X |
| License Number: | 539 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Medical-Surgical |
| Taxonomy Definition: | |