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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366421174 NPPES
Washington MEDICAID 8466955

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