Doctor Name: | CHRISTIE EHLE ERICKSON |
NPI Number: | 1477585172 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | R126067-4 |
Business Practice Address: | 4855 W Arrowhead Rd Hermantown, MN - 558113936 |
Business Phone Number: | 2187863540 |
Business Fax Number: | 2187228160 |
Mailing Address: | 4855 W Arrowhead Rd, HERMANTOWN |
State: | MN |
Postal Code: | 558113936 |
Phone Number: | 2187863540 |
Fax Number: | 2187228160 |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 04/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R126067-4 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |