Healthcare Provider Details

I. General information

NPI: 1730430380
Provider Name (Legal Business Name): ERIN M LYSTAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2012
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 PACIFIC AVE
EVERETT WA
98201-4147
US

IV. Provider business mailing address

2302 GRAND AVE
EVERETT WA
98201-2714
US

V. Phone/Fax

Practice location:
  • Phone: 425-404-4000
  • Fax:
Mailing address:
  • Phone: 206-571-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58323
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60310348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: