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General NPI Number Information
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NPI Number | 1912109729
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Entity Type | Individual
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Provider Name | ANNE MARJORIE ERICKSON-HARE OTA
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 311 NE 3RD ST CAREAGE OF WHIDBEY
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City | COUPEVILLE
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State | WA
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Zip | 98239-3427
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Country | US
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Telephone | 360-678-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2256 WOODBINE RD
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City | LANGLEY
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State | WA
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Zip | 98260-8222
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Country | US
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Telephone | 360-321-2548
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Fax |
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OC00000930
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License Number State | WA
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