Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | PG204690 | OR |
N | 111NI0900X | Internist | PG204690 | OR |
NPI | 1003482068 |
---|---|
Provider Name | Katherine M Erickson |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2021 |
Last Update Date | 11/08/2021 |