Provider Demographics
NPI:1700501509
Name:STARDIG, ERIKA RAE (RN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:RAE
Last Name:STARDIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:RAE
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1410 SE 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-6243
Mailing Address - Country:US
Mailing Address - Phone:503-680-7099
Mailing Address - Fax:
Practice Address - Street 1:1410 SE 121ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6243
Practice Address - Country:US
Practice Address - Phone:503-680-7709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61199822163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN61199822OtherREGISTERED NURSE