Provider Demographics
NPI:1265015341
Name:HOMMERTZHEIM, ERICA LYNN (MSN, APRN, AGPCNP-C)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LYNN
Last Name:HOMMERTZHEIM
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-9017
Mailing Address - Country:US
Mailing Address - Phone:620-253-1148
Mailing Address - Fax:
Practice Address - Street 1:1201 PACIFIC AVE STE 400
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4381
Practice Address - Country:US
Practice Address - Phone:253-300-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSAG03210031363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology