Healthcare Provider Details

I. General information

NPI: 1952238990
Provider Name (Legal Business Name): MICHELLE ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N FERRY ST
ANOKA MN
55303-1650
US

IV. Provider business mailing address

2727 N FERRY ST
ANOKA MN
55303-1650
US

V. Phone/Fax

Practice location:
  • Phone: 612-298-2103
  • Fax:
Mailing address:
  • Phone: 612-298-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1004599
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1620421
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: