Individual provider · Type 1 NPI

Jon Derik Mortensen, PAC

Medical Physician Assistant · Lakewood, WA

NPI number 1407930456 Active

Practice location

10510 Gravelly Lake Dr., Community Health Care - Lakewood Clinic
Lakewood, WA 98499

Call (253) 589-7030 Map

Fax (253) 589-7033

Mailing address

1019 Pacific Ave Ste 300, Attn Hr
Tacoma, WA 98402-4488

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA10005073 (WA)

Medical Physician Assistant: Definition to come...

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About NPI 1407930456

Jon Derik Mortensen, PAC's National Provider Identifier is 1407930456, issued on Oct 25, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Lakewood, WA. The record was last updated on Jun 14, 2012.