Healthcare Provider Details

I. General information

NPI: 1154568376
Provider Name (Legal Business Name): BRIAN E ERDRICH ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR RD STE 240
ANCHORAGE AK
99508-2959
US

IV. Provider business mailing address

2925 DEBARR RD STE 240
ANCHORAGE AK
99508-2959
US

V. Phone/Fax

Practice location:
  • Phone: 907-339-4650
  • Fax: 907-339-4694
Mailing address:
  • Phone: 907-339-4650
  • Fax: 907-339-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number19840
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1229
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: