Basic Information
| Provider Information | |||||||||
| NPI: | 1154571263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCILRATH | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9230 SKY ISLAND DR E # 600NW | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983917385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537506000 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Practice Location | |||||||||
| Address1: | 9230 SKY ISLAND DR E # 600NW | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983917385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537506000 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2008 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 001001540 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA60107666 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2004104 | 05 | WA | MEDICAID |