Healthcare Provider Details

I. General information

NPI: 1982212007
Provider Name (Legal Business Name): ERICA ROSE RONQUILLO DNP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

IV. Provider business mailing address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-7523
  • Fax:
Mailing address:
  • Phone: 541-954-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10000432
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: