JON DERIK MORTENSEN (NPI# 1407930456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1407930456 |
Entity Type | Individual |
Full Name | JON DERIK MORTENSEN |
Credential | PAC |
Practice Address |
10510 Gravelly Lake Dr. Community Health Care - Lakewood Clinic Lakewood WA 98499 |
Mailing Address |
1019 Pacific Ave Ste 300 Attn Hr Tacoma WA 98402-4488 |
Practice Telephone | 2535897030 |
Practice Fax Number | 2535897033 |
Mailing Telephone | 2537221540 |
Enumeration Date | 2006-10-25 |
Last Update Date | 2012-06-14 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10005073 | WA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WA | 8469256 | 05 |
Street Address |
10510 GRAVELLY LAKE DR. COMMUNITY HEALTH CARE - LAKEWOOD CLINIC |
City | LAKEWOOD |
State | WA |
Zip Code | 98499 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275159592 | Sea Mar Community Health Centers | Clinic/Center | 5700 100th Street Se, Suite 510, Lakewood, WA 98499 | 2020-06-23 |
1568018828 | Heather Leigh Andrade | Behavioral Analyst | 6210 75th St W Ste 100, Lakewood, WA 98499 | 2019-08-13 |
1043870876 | Seoul Chinese Herbs Inc | Acupuncturist | 8705 S. Tacoma Way, Lakewood, WA 98499 | 2019-06-14 |
1013572064 | Puget Sound Kidney Centers | Clinic/Center | 11950 47th Ave Sw, Lakewood, WA 98499 | 2019-05-06 |
1447736657 | Marcela Cunan | Counselor | 9330 59th Avenue Southest, Lakewood, WA 98499 | 2018-07-11 |
1609382381 | Leroy Moore IIi | Counselor | 8811 S. Tacoma Way, 106, Lakewood, WA 98499 | 2017-12-18 |
1578077657 | Andrea Gaston | Behavior Technician | 8815 S. Tacoma Way, Suite 122, Lakewood, WA 98499 | 2017-11-27 |
1609389931 | Jennifer King | Social Worker | 5900 100th St Sw Ste 17b, Lakewood, WA 98499 | 2017-11-08 |
1750806337 | Wonyoung Lee | Counselor | 8811 South Tacoma Way, Suite 106, Lakewood, WA 98499 | 2017-08-04 |
1043749443 | Frederick Paltron Edwards | Counselor | 9500 Front Street, Suite 100, Lakewood, WA 98499 | 2017-06-08 |
Find all providers in zip 98499 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457804973 | Rachael Anne Ruscitto | Physician Assistant | 2298 Woodward Ave, Lakewood, OH 44107-5561 | 2016-08-02 |
1588047518 | Geoffrey Slater | Physician Assistant | 285 Zang St Apt 2834, Lakewood, CO 80228-1032 | 2015-07-08 |
1225466824 | Joseph Beren | Physician Assistant | 150 James St Ste 204, Lakewood, NJ 08701-4101 | 2013-10-17 |
1184962649 | Rodger Howard Steinem | Physician Assistant | 5501 W Mississippi Ave, Lakewood, CO 80226-4811 | 2013-01-17 |
1942569553 | Maria Elena Arredondo | Physician Assistant | 5712 Coldbrook Ave, Lakewood, CA 90713-1442 | 2012-05-16 |
1730496886 | Johnna Jaynstein | Physician Assistant | 13300 W 6th Ave, Campus Box 44, Lakewood, CO 80228-1213 | 2010-09-10 |
1881878635 | Christian Angelo Cruz | Physician Assistant | 2529 Greentop St, Lakewood, CA 90712-3609 | 2007-12-28 |
1649499054 | Shinobu Inoue | Physician Assistant | 6210 75th St W Ste A200, Lakewood, WA 98499-8110 | 2007-04-24 |
1134257603 | Michele Lee Saul-langford | Physician Assistant | 2425 Carson St., #22, Lakewood, CA 90712 | 2007-02-28 |
1609812668 | Jon David Allison | Physician Assistant | 13952 Denver West Pkwy Ste 100, Lakewood, CO 80401-3141 | 2006-06-20 |
Find all providers in LAKEWOOD |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.