Provider Demographics
NPI:1528355617
Name:O'LEARY, ERIN C
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:C
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3882
Mailing Address - Country:US
Mailing Address - Phone:503-914-5229
Mailing Address - Fax:503-200-1241
Practice Address - Street 1:1520 N ALBERTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-3602
Practice Address - Country:US
Practice Address - Phone:503-914-5229
Practice Address - Fax:503-200-1241
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200942828RN163WP0808X
OR201150097NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health