Doctor Name: | MRS. BRONWEN KAYE ERICKSON |
NPI Number: | 1154686020 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 201350053NP |
Business Practice Address: | 532 B Laneda Ave Manzanita, OR - 97130 |
Business Phone Number: | 5033684393 |
Business Fax Number: | 5033684395 |
Mailing Address: | 532 B Laneda Ave, Po Box 1387 MANZANITA |
State: | OR |
Postal Code: | 97130 |
Phone Number: | 5033684393 |
Fax Number: | 5033684395 |
NPI Enumeration Date: | 07/06/2012 |
NPI Last Update Date: | 11/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 201350053NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |