Provider Demographics
NPI:1083487300
Name:BURTON, ERICA JENELLE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JENELLE
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:JENELLE
Other - Last Name:DEFILIPPIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3004 NE HOPE DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7739
Mailing Address - Country:US
Mailing Address - Phone:503-803-5989
Mailing Address - Fax:
Practice Address - Street 1:360 SW BOND ST STE 330
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3556
Practice Address - Country:US
Practice Address - Phone:541-706-7730
Practice Address - Fax:541-706-4760
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program