Healthcare Provider Details

I. General information

NPI: 1376652354
Provider Name (Legal Business Name): ERIKA L. THOMAS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W MAIN STREET
ELMA WA
98541
US

IV. Provider business mailing address

PO BOX 513
ELMA WA
98541-0513
US

V. Phone/Fax

Practice location:
  • Phone: 360-229-8308
  • Fax:
Mailing address:
  • Phone: 360-500-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00020810
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: