Healthcare Provider Details

I. General information

NPI: 1164501581
Provider Name (Legal Business Name): STEVEN F ERICKSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 MILL ST
RENO NV
89502-1320
US

IV. Provider business mailing address

9900 WILBUR MAY PKWY APT 3602
RENO NV
89521-3097
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-1019
  • Fax:
Mailing address:
  • Phone: 775-225-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number843
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: