Provider Information for 1063800167
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ERICA ROSENTHAL
Sex: Female
NPI: 1063800167
Last Updated: 2024-10-23
Certification Date: 2024-10-23
Certification Date: 2024-10-23
Details
| Name | Value | ||||||||||||||||
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| NPI | 1063800167 | ||||||||||||||||
| Enumeration Date | 2014-12-26 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 15848 266TH AVE SE ISSAQUAH, WA 98027-6937 United States Phone: 480-848-4275 | Fax: | ||||||||||||||||
| Primary Practice Address | 15848 266TH AVE SE ISSAQUAH, WA 98027-6937 United States Phone: 480-848-4275 | Fax: | ||||||||||||||||
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