Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | OS60696687 | WA |
NPI | 1972160612 |
---|---|
Provider Name | Mrs. Monica D Erickson |
First Address | Spokane, WA 99201-0402 |
Second Address | Spokane, WA 99201-0402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 22/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003137000 | (05) | ID |
566943 | (05) | MT |
9028838 | (05) | WA |