MARY ERICKSON (ENP, FNP) – Nurse Practitioner, NPI 1417632852

MARY ERICKSON (ENP, FNP) is a healthcare provider. based in Redmond, Oregon. specializing in NURSE PRACTITIONER. They hold the professional credentials ENP, FNP. They hold a License No. E06230009 (OR). The NPI Number for MARY ERICKSON (ENP, FNP) is 1417632852

Main info

Female
Sole Proprietor
3 Years Of Experience
Name
MARY ERICKSON (ENP, FNP)
NPI
1417632852
Phone
(541) 213-8195
Address
1253 NW CANAL BLVD
Enumeration Date
21 June 2023
Last Update Date
14 May 2024

Doctor Profile

Medical School Name
VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5417632725
Graduation Year
2023 (3 years ago)
PAC ID
7719338722
Group Practice PAC ID
2163460726
Professional Enrollment ID
I20240103004001
Address ID
OR978308371FO712XXSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

3,366 NURSE PRACTITIONER in OR

Provider Addresses for MARY ERICKSON (ENP, FNP)

  • 1253 NW CANAL BLVD

    REDMOND, OR 977561334

    Phone: (541) 213-8195

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-01-03

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240103004001INurse PractitionerORTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97756)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2163460726View full group profile
NameSpecialtyState
Clinical Social WorkerTX
Physician AssistantOR
Nurse PractitionerOR
Nurse PractitionerKS

Reviews

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Frequently asked questions

What is the standard ID for MARY ERICKSON (ENP, FNP) in the U.S.?
In the U.S., MARY ERICKSON (ENP, FNP) is identified by NPI 1417632852.
Is MARY ERICKSON (ENP, FNP)'s NPI status active today?
Active status means MARY ERICKSON (ENP, FNP)'s NPI record is not deactivated in the public file.
What type of care does MARY ERICKSON (ENP, FNP) provide?
MARY ERICKSON (ENP, FNP)'s profile centers on Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is MARY ERICKSON (ENP, FNP) tied to Redmond, Oregon?
If you are local to Redmond, Oregon, MARY ERICKSON (ENP, FNP) may be relevant to your search.
Why is information missing for MARY ERICKSON (ENP, FNP)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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