Healthcare Provider Details

I. General information

NPI: 1326253501
Provider Name (Legal Business Name): KRISTIN ELISE ERICKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE MEDICAL EVALUATION BOARD
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040 JACKSON AVE MEDICAL EVALUATION BOARD
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number01060086A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: