Prieskorn, Thomas Russell
Prieskorn, Thomas Russell is an individual health care provider with primary practice located at 901 Mountain View Dr , Shelton WA 98584-4401. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Prieskorn, Thomas Russell can be contacted via phone (360) 426-1611.Contact Information
Primary practice address
901 Mountain View Dr
Shelton WA 98584-4401
Phone: (360) 426-1611
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA10004942 | Washington |
Profile Details
NPI number | 1366421174 |
---|---|
LBN Legal business name | Prieskorn, Thomas Russell |
Credentials | Physician's Assistant Certified (PA-C) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jan 10th, 2006 |
Last updated | Mar 3rd, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1366421174 | NPPES |
Washington | MEDICAID | 8466955 |
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