Healthcare Provider Details

I. General information

NPI: 1114742871
Provider Name (Legal Business Name): HEIDI ERICKSON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2486 N PONDEROSA DR STE D211
CAMARILLO CA
93010-2470
US

IV. Provider business mailing address

396 ESTRELLA ST
VENTURA CA
93003-1604
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-2818
  • Fax:
Mailing address:
  • Phone: 530-966-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95030689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: