Individual
MR. THOMAS RUSSELL PRIESKORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
901 MOUNTAIN VIEW DR, SHELTON, WA 98584-4401
(360) 426-1611
Mailing address
PO BOX 1668, SHELTON, WA 98584-5001
(360) 426-1611
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10004942
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8466955
—
WA
Enumeration date
01/10/2006
Last updated
03/03/2015
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