Provider Demographics
NPI:1851607196
Name:DEGENHARDT, ERICA MARISA JONES (NP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARISA JONES
Last Name:DEGENHARDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARISA HAINDL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:13KPV
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-346-1358
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20152363LA2100X
OR201050172NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care