Provider Demographics
NPI:1225827587
Name:ERICKSON, SPENCER EMIL (RN, NP)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:EMIL
Last Name:ERICKSON
Suffix:
Gender:
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 NW 12TH AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3071
Mailing Address - Country:US
Mailing Address - Phone:716-338-2581
Mailing Address - Fax:
Practice Address - Street 1:930 NW 12TH AVE APT 514
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3071
Practice Address - Country:US
Practice Address - Phone:716-338-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY783424163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine