Healthcare Provider Details

I. General information

NPI: 1043899875
Provider Name (Legal Business Name): ERIN HANLON GENEREUX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NW LARCH AVE
REDMOND OR
97756-1357
US

IV. Provider business mailing address

454 NE REVERE AVE
BEND OR
97701-4019
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-2164
  • Fax: 541-598-3494
Mailing address:
  • Phone: 971-412-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202111754NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: