Healthcare Provider Details

I. General information

NPI: 1992798573
Provider Name (Legal Business Name): DIXIE D ERICKSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY SUITE 216
ANCHORAGE AK
99508-5222
US

IV. Provider business mailing address

PO BOX 202113
ANCHORAGE AK
99520-2113
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-2873
  • Fax: 907-563-5852
Mailing address:
  • Phone: 907-929-8704
  • Fax: 907-929-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number460
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: