Healthcare Provider Details

I. General information

NPI: 1124962881
Provider Name (Legal Business Name): CHRISTINA RENEE ERICKSON RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WISHER DR
SPENCERVILLE OH
45887-1293
US

IV. Provider business mailing address

2500 WISHER DR
SPENCERVILLE OH
45887-1293
US

V. Phone/Fax

Practice location:
  • Phone: 419-647-4111
  • Fax: 419-647-5124
Mailing address:
  • Phone: 419-647-4111
  • Fax: 419-647-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.389257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: