Provider Demographics
NPI:1861584161
Name:KERSHISNIK, ERIN KATHLEEN O'NEEL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHLEEN O'NEEL
Last Name:KERSHISNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1603 COOPER POINT RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8325
Mailing Address - Country:US
Mailing Address - Phone:360-438-1161
Mailing Address - Fax:360-438-6690
Practice Address - Street 1:1603 COOPER POINT RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8325
Practice Address - Country:US
Practice Address - Phone:360-438-1161
Practice Address - Fax:360-438-6690
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000035135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8224685Medicaid
G74335Medicare UPIN
AB16692Medicare ID - Type Unspecified