Healthcare Provider Details

I. General information

NPI: 1447212444
Provider Name (Legal Business Name): MYREDA LYNN ERICKSON-O'BRIEN RNC, MS, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYREDA LYNN ERICKSON RNC, MS, NNP

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NAVAL MEDICAL CENTER
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

934 B AVE
CORONADO CA
92118-2606
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8910
  • Fax:
Mailing address:
  • Phone: 619-437-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR076699
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number395189
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberNP076699
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number14261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: