Doctor Name: | MRS. ERICA SOUDERS |
NPI Number: | 1104139336 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC, APN |
License Number: | 209008212 |
Business Practice Address: | 800 Broadview Village Sq Broadview Broadview, IL - 601554887 |
Business Phone Number: | 7087315555 |
Business Fax Number: | |
Mailing Address: | 1000 Nicollet Mall # 1797, Minneapolis MINNEAPOLIS |
State: | MN |
Postal Code: | 554032542 |
Phone Number: | 6126965510 |
Fax Number: | |
NPI Enumeration Date: | 07/16/2010 |
NPI Last Update Date: | 10/12/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209008212 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |