Provider Demographics
NPI:1114199908
Name:ERICKSON HURT, CARMA J (CNS)
Entity Type:Individual
Prefix:
First Name:CARMA
Middle Name:J
Last Name:ERICKSON HURT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2150
Mailing Address - Country:US
Mailing Address - Phone:541-269-2986
Mailing Address - Fax:541-269-7987
Practice Address - Street 1:1610 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2150
Practice Address - Country:US
Practice Address - Phone:541-269-2986
Practice Address - Fax:541-269-7987
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200743222163WH1000X
OR200770015364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice