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Individual

MRS. JENNIFER MARIE ERICKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3021 GRIFFIN AVE, ENUMCLAW, WA 98022-2369
(360) 825-6511
(360) 825-6536
Mailing address
26458 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8350
(425) 690-3460

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60157486
WA
363AM0700X
Medical Physician Assistant
PA60157486
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0268930
STATE L&I
WA
Enumeration date
06/07/2010
Last updated
02/25/2022
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