1861584161 NPI number — DR. ERIN KATHLEEN O'NEEL KERSHISNIK MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861584161 NPI number — DR. ERIN KATHLEEN O'NEEL KERSHISNIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERSHISNIK
Provider First Name:
ERIN
Provider Middle Name:
KATHLEEN O'NEEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861584161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3703 ENSIGN RD NE
Provider Second Line Business Mailing Address:
SUITE 10-A
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98506-5038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-438-1161
Provider Business Mailing Address Fax Number:
360-438-6690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3703 ENSIGN RD NE
Provider Second Line Business Practice Location Address:
SUITE 10-A
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506-5038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-438-1161
Provider Business Practice Location Address Fax Number:
360-438-6690
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8224685 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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