=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184925778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ELIZABETH RIGHTER PA-C, MPAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2010
-----------------------------------------------------
Last Update Date | 12/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2643 NW RALEIGH ST UNIT 32
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97210-2777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-581-7783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2643 NW RALEIGH ST UNIT 32
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97210-2777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-581-7783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA153096
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------