Healthcare Provider Details

I. General information

NPI: 1336871680
Provider Name (Legal Business Name): ERIKA RHIANNON BUTKIEWICZ PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA R KOSLOSKI

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E SUPERIOR ST STE 301
DULUTH MN
55802-2207
US

IV. Provider business mailing address

1001 E SUPERIOR ST STE 301
DULUTH MN
55802-2207
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5555
  • Fax:
Mailing address:
  • Phone: 218-249-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14821
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: