MEDICARE: MRS. ERIN SANFORD FITZGERALD FNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	201507586NP-PP	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	201507586NP-PP	OR

General Provider Information

NPI Number	:	1306217872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN SANFORD FITZGERALD FNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 2792
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-2792
Country	:	US
Telephone Number	:	971-465-9556
Fax Number	:	888-224-4514

Provider Business Practice Location Address
First Line	:	820 SE HIGHWAY 101 STE E2
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-2773
Country	:	US
Telephone Number	:	971-465-9556
Fax Number	:	888-224-4514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	02/26/2025

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