Healthcare Provider Details

I. General information

NPI: 1376776898
Provider Name (Legal Business Name): EMILY R ERICKSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

PO BOX 4925
DES MOINES IA
50305-4925
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-3211
  • Fax: 515-643-8933
Mailing address:
  • Phone: 515-247-3211
  • Fax: 515-643-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002028
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: