Provider Demographics
NPI:1225599871
Name:FORTUNA, ERIN KALEENA
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KALEENA
Last Name:FORTUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 W MAIN ST APT S164
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-9005
Mailing Address - Country:US
Mailing Address - Phone:818-736-2292
Mailing Address - Fax:
Practice Address - Street 1:872 W MAIN ST APT S164
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-9005
Practice Address - Country:US
Practice Address - Phone:818-736-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN