Individual
ERICA MARIE DIVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
14095 SW WALKER RD APT 144, BEAVERTON, OR 97005-1075
(503) 415-1741
Mailing address
14095 SW WALKER RD APT 144, BEAVERTON, OR 97005-1075
(503) 415-1741
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201230646LPN
OR
Other
Enumeration date
06/06/2014
Last updated
06/06/2014
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