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General NPI Number Information
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NPI Number | 1376836981
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Entity Type | Individual
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Provider Name | TIMOTHY A ERICSON FNP
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Gender | Male
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 12/02/2017
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Provider Practice Location Address
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Address Line | 1475 MT HOOD AVE.
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City | WOODBURN
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State | OR
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Zip | 97071
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Country | US
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Telephone | 503-982-2174
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Fax | 503-982-4599
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | WOODBURN
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State | OR
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Zip | 97071-0278
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Country | US
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Telephone | 971-983-5260
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Fax | 971-983-5326
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP 20561
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201394165NP-PP
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License Number State | OR
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