Healthcare Provider Details

I. General information

NPI: 1235662610
Provider Name (Legal Business Name): EMMA LINNEA SIELING ERICKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA LINNEA SIELING M.D.

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5123
  • Fax:
Mailing address:
  • Phone: 320-763-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64463
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: