Provider Demographics
NPI:1376201103
Name:POGUE, ERICA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:POGUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:RIEKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4881 NW BRYCE CT
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9268
Mailing Address - Country:US
Mailing Address - Phone:573-263-9260
Mailing Address - Fax:
Practice Address - Street 1:4881 NW BRYCE CT
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9268
Practice Address - Country:US
Practice Address - Phone:573-263-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61224324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily