Provider Demographics
NPI:1043793581
Name:ERICKSON, CAITLYN (PA)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SE OAK ST STE F
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4147
Mailing Address - Country:US
Mailing Address - Phone:971-228-8855
Mailing Address - Fax:503-206-0118
Practice Address - Street 1:545 SE OAK ST STE F
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4147
Practice Address - Country:US
Practice Address - Phone:971-228-8855
Practice Address - Fax:503-206-0118
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical