Provider Demographics
NPI:1629191705
Name:SODERMAN, ERIKA ANNE (NP-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ANNE
Last Name:SODERMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 N ORACLE RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6986
Mailing Address - Country:US
Mailing Address - Phone:520-544-2273
Mailing Address - Fax:520-544-4227
Practice Address - Street 1:7725 N ORACLE RD
Practice Address - Street 2:SUITE 131
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-6986
Practice Address - Country:US
Practice Address - Phone:520-544-2273
Practice Address - Fax:520-544-4227
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1004363L00000X
AZAP2626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200206Medicaid
AZ200206Medicaid