Provider Demographics
NPI:1205928652
Name:ERICKSON, WILLIAM E (ANP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:ERICKSON
Suffix:
Gender:
Credentials:ANP
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 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:
Practice Address - Street 1:222 NE PARK PLAZA DR
Practice Address - Street 2:STE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5899
Practice Address - Country:US
Practice Address - Phone:360-254-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61092109363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP47963Medicaid
AK153297OtherGRP #
AKME0979762OtherDEA #
AKP97919Medicare UPIN
AKK153299Medicare ID - Type Unspecified