Individual
TARA ERICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4224 NE HALSEY ST STE 335, PORTLAND, OR 97213-1568
(503) 922-6616
Mailing address
6944 SE STARK ST, PORTLAND, OR 97215-2153
(503) 997-2222
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202105081
OR
363LW0102X
Women's Health Nurse Practitioner
NP95010525
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202105081
NURSE PRACTITIONER LICENSE
OR
01
—
NP95010525
NURSE PRACTITIONER AND FURNISHING LICENSE
CA
Enumeration date
01/08/2019
Last updated
04/18/2024
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