Healthcare Provider Details

I. General information

NPI: 1376447623
Provider Name (Legal Business Name): LISA A ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 120TH ST
BOONE IA
50036-7336
US

IV. Provider business mailing address

1644 120TH ST
BOONE IA
50036-7336
US

V. Phone/Fax

Practice location:
  • Phone: 712-830-8241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number112704
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: