Healthcare Provider Details

I. General information

NPI: 1194149625
Provider Name (Legal Business Name): ERIKA GARY RN, MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAWS AVE
UKIAH CA
95482-6540
US

IV. Provider business mailing address

2839 GEORGIA ST
OAKLAND CA
94602-3221
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number812579
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: