Provider Demographics
NPI:1700037769
Name:LINNELL, ERICA K (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:K
Last Name:LINNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S 38TH CT
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5777
Mailing Address - Country:US
Mailing Address - Phone:425-970-4155
Mailing Address - Fax:
Practice Address - Street 1:350 S 38TH CT
Practice Address - Street 2:SUITE 115
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5777
Practice Address - Country:US
Practice Address - Phone:425-970-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL2965390200000X
WAMD60279708207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021804Medicaid
WA2021804Medicaid