person
Jon Derik Mortensen, PAC
Medical Physician Assistant in Lakewood, Washington
NPI 1407930456

Jon Derik Mortensen is a Medical Physician Assistant based in Tacoma, WA and is specialized in Medical. Jon Derik Mortensen practices in Lakewood, WA and has the professional credentials of PAC. The NPI Number for Jon Derik Mortensen is 1407930456 and holds a License No. PA10005073 (Washington).

The current practice location address for Jon Derik Mortensen is 10510 Gravelly Lake Dr., Lakewood, WA and can be reached out via phone at 253-589-7030 and via fax at 253-589-7033. You can also correspond with Jon Derik Mortensen through the mailing address at 1019 PACIFIC AVE STE 300, TACOMA, WA - 98402-4488 (mailing address contact number: 253-722-1540).

Location: 10510 Gravelly Lake Dr., Lakewood, WA, 98402-4488
person
Provider Profile Details
NPI Number
1407930456
Provider Name
Jon Derik Mortensen
Credential
PAC
Provider Entity Type
Individual
Gender
Male
Address
10510 Gravelly Lake Dr., Lakewood, WA, 98402-4488
Phone Number
253-589-7030
Fax Number
253-589-7033
Provider Enumeration Date
10/25/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
8469256 05 WA
institution
Provider Business Practice Location Address Details
Address
10510 Gravelly Lake Dr.
City
State
Zip
98499
Phone Number
253-589-7030
Fax Number
253-589-7033
person
Provider Business Mailing Address Details
Address
1019 Pacific Ave Ste 300
City
State
Zip
98402-4488
Phone Number
253-722-1540
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA10005073 (Washington)
Definition
Definition to come...
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