Basic Information
| Provider Information | |||||||||
| NPI: | 1265015341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOMMERTZHEIM | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MSN, APRN, AGPCNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8005 STATE ROAD 23 | ||||||||
| Address2: | |||||||||
| City: | CIMARRON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678359017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202531148 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 PACIFIC AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533008453 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2021 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AG03210031 | KS | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | AG03210031 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP2300X | AG03210031 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.