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General NPI Number Information
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NPI Number | 1053368340
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Entity Type | Individual
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Provider Name | EDWARD ERICSON HOLDEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 600 NE 92ND AVE
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City | VANCOUVER
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State | WA
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Zip | 98664-3225
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Country | US
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Telephone | 360-514-2142
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Fax | 360-514-6820
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Provider Business Mailing Address
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Address Line | PO BOX 1600 UNIT 282
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City | VANCOUVER
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State | WA
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Zip | 98668-1600
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Country | US
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Telephone | 360-514-2142
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Fax | 360-514-6820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10004163
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00610
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License Number State | OR
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