Mortensen, Jon Derik
Mortensen, Jon Derik is an individual health care provider with primary practice located at 10510 Gravelly Lake Dr. Community Health Care - Lakewood Clinic, Lakewood WA 98499. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Mortensen, Jon Derik can be contacted via phone (253) 589-7030.Contact Information
Primary practice address
10510 Gravelly Lake Dr. Community Health Care - Lakewood Clinic
Lakewood WA 98499
Phone: (253) 589-7030
Fax: (253) 589-7033
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA10005073 | Washington |
Profile Details
| NPI number | 1407930456 |
|---|---|
| LBN Legal business name | Mortensen, Jon Derik |
| Credentials | PAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 25th, 2006 |
| Last updated | Jun 14th, 2012 - about 14 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 | 1407930456 | NPPES |
| Washington | MEDICAID | 8469256 |
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