Basic Information
| Provider Information | |||||||||
| NPI: | 1134269897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHONY | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24366 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065980502 | ||||||||
| FaxNumber: | 2065980516 | ||||||||
| Practice Location | |||||||||
| Address1: | 4245 ROOSEVELT WAY NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981056008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065985500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP30006019 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 163W00000X | RN00134831 | WA | N | Nursing Service Providers | Registered Nurse | 367A00000X | AP30006019 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 0129049 | 01 | WA | LABOR & INDUSTRY | OTHER | 85804U | 01 | WA | REGENCE BLUE SHIELD | OTHER | 9632480 | 05 | WA | MEDICAID |