Healthcare Provider Details

I. General information

NPI: 1760745228
Provider Name (Legal Business Name): ERIKA J HUNT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA J KOSMATKA PA

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COLUMBIA RD
GRAND FORKS ND
58201-4036
US

IV. Provider business mailing address

PO BOX 6002
GRAND FORKS ND
58206-6002
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6000
  • Fax: 701-780-5772
Mailing address:
  • Phone: 701-780-5000
  • Fax: 701-780-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0485
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: