Healthcare Provider Details

I. General information

NPI: 1679420418
Provider Name (Legal Business Name): ERIN ELIZABETH ENNIS BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SW LOWER BOONES FERRY RD
PORTLAND OR
97224-7258
US

IV. Provider business mailing address

18040 SW LOWER BOONES FERRY RD
PORTLAND OR
97224-7258
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-0700
  • Fax: 503-216-0750
Mailing address:
  • Phone: 503-216-0700
  • Fax: 503-216-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number201501480RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: