JON DERIK MORTENSEN

LAKEWOOD, WA
NPI1407930456
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: WA  PA10005073)
Enumeration Date2006-10-25
Last Update Date2012-06-14
Business Address
-- JON DERIK MORTENSEN PAC
10510 GRAVELLY LAKE DR. COMMUNITY HEALTH CARE - LAKEWOOD CLINIC
LAKEWOOD, WA 98499
Phone number: 253-589-7030
Mailing Address
-- JON DERIK MORTENSEN PAC
1019 PACIFIC AVE STE 300 ATTN HR
TACOMA, WA 98402-4488
Phone number: 253-722-1540
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