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General NPI Number Information
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NPI Number | 1679805766
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Entity Type | Individual
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Provider Name | ERIN JAMIE VAN DYKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 1508 DIVISION ST SUITE 105
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City | OREGON CITY
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State | OR
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Zip | 97045-1582
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Country | US
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Telephone | 503-656-0836
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Fax | 503-656-9464
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Provider Business Mailing Address
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Address Line | 1508 DIVISION ST SUITE 105
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City | OREGON CITY
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State | OR
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Zip | 97045-1582
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Country | US
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Telephone | 503-905-4104
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Fax | 503-656-9464
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA157440
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA157440
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License Number State | OR
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