Provider Demographics
NPI:1174326607
Name:ERICKSEN, TAWANNA DESHAY (RN)
Entity type:Individual
Prefix:MRS
First Name:TAWANNA
Middle Name:DESHAY
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAWANNA
Other - Middle Name:DESHAY
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6200 DE SOTO AVE APT 35401
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-0205
Mailing Address - Country:US
Mailing Address - Phone:302-632-1038
Mailing Address - Fax:
Practice Address - Street 1:8405 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3401
Practice Address - Country:US
Practice Address - Phone:323-653-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95352839163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95352839OtherBOARD OF NURSING