JON DERIK MORTENSEN


Address: 10510 Gravelly Lake Dr., Community Health Care - Lakewood Clinic, Lakewood, WA 98499
Phone: 2535897030

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
PA10005073 WA Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WA 8469256 05

Office Location

Street Address 10510 GRAVELLY LAKE DR.
COMMUNITY HEALTH CARE - LAKEWOOD CLINIC
City LAKEWOOD
State WA
Zip Code 98499

Providers in the same zip code

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 Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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

Competitor

Search similar providers

City LAKEWOOD
Zip Code 98499

Improve Information

Please comment or provide details below to improve the information on JON DERIK MORTENSEN.

Dataset Information

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.

Trending Searches