Basic Information
| Provider Information | |||||||||
| NPI: | 1831577196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERIKSON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | DIETRICH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033254321 | ||||||||
| FaxNumber: | 4062584732 | ||||||||
| Practice Location | |||||||||
| Address1: | 1639 SE ENSIGN LN STE B103 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033384500 | ||||||||
| FaxNumber: | 5033384501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2015 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 189802 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.