Provider Demographics
NPI:1821463589
Name:WEGGENMAN, ERRYN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ERRYN
Middle Name:
Last Name:WEGGENMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9775 SW WILSHIRE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5067
Mailing Address - Country:US
Mailing Address - Phone:503-646-0101
Mailing Address - Fax:
Practice Address - Street 1:9775 SW WILSHIRE ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5067
Practice Address - Country:US
Practice Address - Phone:503-646-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant