Provider Demographics
NPI:1285635490
Name:LENZA, ERIN M (PAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:LENZA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:STE B-2003
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-752-7705
Mailing Address - Fax:253-752-0113
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:STE B-2003
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-752-7705
Practice Address - Fax:253-752-0113
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3189EOtherREGENCE BLUE SHIELD
WA8379588Medicaid
WAG8800578Medicare ID - Type Unspecified
WA3189EOtherREGENCE BLUE SHIELD