MEDICARE: MRS. CHERYL LYNN ERICKSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71000493A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	500020243	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000284072	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194713644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL LYNN ERICKSON NP

Provider Business Mailing Address
First Line	:	1310 SHOREVIEW DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-1369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4813 NEW HAVEN AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-3018
Country	:	US
Telephone Number	:	260-449-7504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/28/2012

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