Provider Demographics
NPI:1467507723
Name:NEALEY, ERIKA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:MARIE
Last Name:NEALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIKA
Other - Middle Name:MARIE
Other - Last Name:COWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1304 FAWCETT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1900
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:245-376-1420
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1840632085R0202X
WAMD603842242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2018715Medicaid