Provider Demographics
NPI:1144289570
Name:NYSTROM, ERIN DIANE (ATC)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:DIANE
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 S 233RD PL
Mailing Address - Street 2:FF204
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4855
Mailing Address - Country:US
Mailing Address - Phone:206-962-1416
Mailing Address - Fax:
Practice Address - Street 1:6012 S 233RD PL
Practice Address - Street 2:FF204
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4855
Practice Address - Country:US
Practice Address - Phone:206-962-1416
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer