Provider Demographics
NPI:1881006997
Name:DITTMER, ERIN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:DITTMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-8400
Mailing Address - Fax:541-732-8401
Practice Address - Street 1:920 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6169
Practice Address - Country:US
Practice Address - Phone:541-732-8400
Practice Address - Fax:541-732-8401
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201503484NP-PP363LA2200X
TN18155363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health