Healthcare Provider Details

I. General information

NPI: 1881166627
Provider Name (Legal Business Name): ERICA N DICKSON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA SCHOBER

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-830-1166
  • Fax:
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202003092NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60911408
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number202003092NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP60911408
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: