Provider Demographics
NPI:1659700029
Name:AKBARI, ERICA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ELIZABETH
Last Name:AKBARI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ELIZABETH
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 8100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0900
Mailing Address - Country:US
Mailing Address - Phone:305-399-2470
Mailing Address - Fax:503-375-7429
Practice Address - Street 1:2531 BOONE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9675
Practice Address - Country:US
Practice Address - Phone:503-399-2470
Practice Address - Fax:503-375-7429
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51265363AM0700X
ORPA167387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPO1435741OtherRAILROAD MEDICARE
OR500675552Medicaid
ORR176642Medicare PIN