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General NPI Number Information
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NPI Number | 1790988228
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Entity Type | Individual
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Provider Name | CYNTHIA ERICKSON LMP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9125 CENTRAL VALLEY RD.
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City | BREMERTON
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State | WA
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Zip | 98311
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Country | US
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Telephone | 360-509-4264
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Fax | 360-779-4076
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Provider Business Mailing Address
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Address Line | 190 NE STATE HWY 308
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City | POULSBO
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State | WA
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Zip | 98370
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Country | US
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Telephone | 360-509-4264
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Fax | 360-779-4076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00017886
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License Number State | WA
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