Provider Demographics
NPI:1821759937
Name:ERWIN, JIMMIE DON III (CNAII)
Entity Type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:DON
Last Name:ERWIN
Suffix:III
Gender:M
Credentials:CNAII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 SW 192ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-3030
Mailing Address - Country:US
Mailing Address - Phone:503-709-8100
Mailing Address - Fax:
Practice Address - Street 1:5435 SW 192ND AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-3030
Practice Address - Country:US
Practice Address - Phone:503-709-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201705353CNA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121616OtherMODA