Provider Demographics
NPI:1619125689
Name:ERICKSON, CHRISTINE JOY (RN, APNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JOY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RN, APNP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:JOY
Other - Last Name:SMUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8675 SW GARDEN HOME RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7354
Mailing Address - Country:US
Mailing Address - Phone:608-234-7928
Mailing Address - Fax:
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-413-6862
Practice Address - Fax:503-413-2879
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139367-030163W00000X
OR097006506163W00000X
WI2297-033363LA2200X
OR201603909NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse