Healthcare Provider Details

I. General information

NPI: 1376201103
Provider Name (Legal Business Name): ERICA NICOLE POGUE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA NICOLE RIEKEN

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 NW BRYCE CT
SILVERDALE WA
98383-9268
US

IV. Provider business mailing address

4881 NW BRYCE CT
SILVERDALE WA
98383-9268
US

V. Phone/Fax

Practice location:
  • Phone: 573-263-9260
  • Fax:
Mailing address:
  • Phone: 573-263-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61224324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: