MEDICARE: ERICA K LINNELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	TL2965	CO
2	207N00000X	Dermatology Physician	MD60279708	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700037769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA K LINNELL MD

Provider Business Mailing Address
First Line	:	350 S 38TH CT
Second Line	:	SUITE 115
City	:	RENTON
State	:	WA
Zip	:	98055-5777
Country	:	US
Telephone Number	:	425-970-4155
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S 38TH CT
Second Line	:	SUITE 115
City	:	RENTON
State	:	WA
Zip	:	98055-5777
Country	:	US
Telephone Number	:	425-970-4155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	03/14/2014

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