Healthcare Provider Details

I. General information

NPI: 1689129710
Provider Name (Legal Business Name): PATTI ERIKSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

IV. Provider business mailing address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

V. Phone/Fax

Practice location:
  • Phone: 712-279-3124
  • Fax: 712-233-8026
Mailing address:
  • Phone: 712-279-3124
  • Fax: 712-233-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number50322
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: