Healthcare Provider Details

I. General information

NPI: 1568982486
Provider Name (Legal Business Name): KARI ELLEN ERICKSON DNP CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

1059 CRESTVIEW DR S
MAPLEWOOD MN
55119-5935
US

V. Phone/Fax

Practice location:
  • Phone: 651-273-3000
  • Fax:
Mailing address:
  • Phone: 651-260-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number183250-7
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP5244
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: