Healthcare Provider Details

I. General information

NPI: 1720216781
Provider Name (Legal Business Name): ERIN K BOYLSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN K TANAKA MD

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

IV. Provider business mailing address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4267
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3300
  • Fax: 253-596-3301
Mailing address:
  • Phone: 253-596-3300
  • Fax: 253-596-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61201088
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25806
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61201088
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: