Provider Demographics
NPI:1922588151
Name:ERICKSON, NATASHA CHRISTINE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:CHRISTINE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 TROJAN CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2329
Mailing Address - Country:US
Mailing Address - Phone:909-228-8631
Mailing Address - Fax:
Practice Address - Street 1:14901 TROJAN CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2329
Practice Address - Country:US
Practice Address - Phone:909-228-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant