Provider Demographics
NPI:1144780255
Name:VANG-ERICKSON, JASON (RN-BSN, PP-NP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:VANG-ERICKSON
Suffix:
Gender:M
Credentials:RN-BSN, PP-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVENUE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:35859 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:OR
Practice Address - Zip Code:97455-9651
Practice Address - Country:US
Practice Address - Phone:541-767-5200
Practice Address - Fax:541-937-1370
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201905929363LF0000X
ORF06191484363LF0000X
MN10290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500772427Medicaid