Healthcare Provider Details

I. General information

NPI: 1760309090
Provider Name (Legal Business Name): HEATHER ERICKSEN SERVICE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 ELM AVE
RAHWAY NJ
07065-2637
US

IV. Provider business mailing address

815 ELM AVE
RAHWAY NJ
07065-2637
US

V. Phone/Fax

Practice location:
  • Phone: 347-996-8386
  • Fax:
Mailing address:
  • Phone: 347-996-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: