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General NPI Number Information
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NPI Number | 1114742871
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Entity Type | Individual
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Provider Name | HEIDI ERICKSON PNP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 2486 N PONDEROSA DR STE D211
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City | CAMARILLO
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State | CA
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Zip | 93010-2470
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Country | US
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Telephone | 805-484-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 396 ESTRELLA ST
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City | VENTURA
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State | CA
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Zip | 93003-1604
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Country | US
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Telephone | 530-966-5697
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95030689
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License Number State | CA
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