Provider Demographics
NPI:1326445651
Name:BERNTSEN, ERIK (CPCP)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:BERNTSEN
Suffix:
Gender:M
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SW VERMONT ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1945
Mailing Address - Country:US
Mailing Address - Phone:503-954-1629
Mailing Address - Fax:
Practice Address - Street 1:1820 SW VERMONT ST
Practice Address - Street 2:SUITE K
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1945
Practice Address - Country:US
Practice Address - Phone:503-954-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-TA-10133461246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical