Provider Demographics
NPI:1598956252
Name:EKERSON, PRISCILLA NOEL
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:NOEL
Last Name:EKERSON
Suffix:
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:PRISCILLA
Other - Middle Name:NOEL
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-985-6403
Mailing Address - Fax:253-985-6879
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-985-6403
Practice Address - Fax:253-985-6879
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574160163W00000X
CA080296367500000X
WAAP60565020367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse