Provider Demographics
NPI:1558383430
Name:ERB, NANCY A (GNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:ERB
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7379
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0339
Mailing Address - Country:US
Mailing Address - Phone:541-469-2015
Mailing Address - Fax:541-469-7465
Practice Address - Street 1:16209 W HOFFELDT LN
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9470
Practice Address - Country:US
Practice Address - Phone:541-469-2015
Practice Address - Fax:541-469-7465
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650088363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006510Medicaid
ORQ76467Medicare UPIN
ORR136830Medicare PIN