Healthcare Provider Details

I. General information

NPI: 1730756560
Provider Name (Legal Business Name): ERICA L TANBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 NW RICHMOND BEACH RD
SHORELINE WA
98177-3121
US

IV. Provider business mailing address

30 HUNTER LN
CAMP HILL PA
17011-2499
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-9688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number60573894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: