Provider Demographics
NPI:1154986065
Name:DAUTREMONT, ERIN ASHLEY (DO)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ASHLEY
Last Name:DAUTREMONT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2930 S MERIDIAN STE 200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1654
Mailing Address - Country:US
Mailing Address - Phone:253-445-7600
Mailing Address - Fax:253-864-5999
Practice Address - Street 1:2930 S MERIDIAN STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1654
Practice Address - Country:US
Practice Address - Phone:253-445-7600
Practice Address - Fax:253-864-5999
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP61252300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2211703Medicaid