Provider Demographics
NPI:1902615198
Name:MOBERG, ERICA JANAE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:JANAE
Last Name:MOBERG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 CALLE CORONADO SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-5618
Mailing Address - Country:US
Mailing Address - Phone:505-429-4172
Mailing Address - Fax:
Practice Address - Street 1:7007 JEFFERSON ST NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4450
Practice Address - Country:US
Practice Address - Phone:505-340-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily