Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 201050086NP | OR |
NPI | 1003945916 |
---|---|
Provider Name | Elise N Erickson |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 20/06/2012 |