Healthcare Provider Details

I. General information

NPI: 1467188623
Provider Name (Legal Business Name): NORA MARIE ERDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WEBBER ST
WHITE BEAR LAKE MN
55110-3407
US

IV. Provider business mailing address

1900 WEBBER ST
WHITE BEAR LAKE MN
55110-3407
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-1822
  • Fax:
Mailing address:
  • Phone: 651-232-1822
  • Fax: 651-232-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number2097985
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: