Provider Demographics
NPI:1396083242
Name:SIMONICH, ERICA LYNN (WHNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:SIMONICH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N KILLINGSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4436
Mailing Address - Country:US
Mailing Address - Phone:503-770-0670
Mailing Address - Fax:833-450-6082
Practice Address - Street 1:1901 N KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4436
Practice Address - Country:US
Practice Address - Phone:503-770-0670
Practice Address - Fax:833-450-6082
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60577137363L00000X
TX721409363LW0102X
OR201400201NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035849Medicaid
OR500670034Medicaid
OR185552Medicare PIN