Provider Demographics
NPI:1447212444
Name:ERICKSON-O'BRIEN, MYREDA LYNN (RNC, MS, NNP)
Entity type:Individual
Prefix:MS
First Name:MYREDA
Middle Name:LYNN
Last Name:ERICKSON-O'BRIEN
Suffix:
Gender:F
Credentials:RNC, MS, NNP
Other - Prefix:MS
Other - First Name:MYREDA
Other - Middle Name:LYNN
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC, MS, NNP
Mailing Address - Street 1:934 B AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2606
Mailing Address - Country:US
Mailing Address - Phone:619-437-8134
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NAVAL MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-532-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076699163WN0002X
CA395189163WN0002X
MDNP076699363LN0005X
CA14261363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care