Healthcare Provider Details

I. General information

NPI: 1376118364
Provider Name (Legal Business Name): ERICA MARIE NORTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 05/28/2024
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 22ND ST
SIOUX FALLS SD
57105-1554
US

IV. Provider business mailing address

5100 S GRAYSTONE AVE UNIT 402
SIOUX FALLS SD
57108-7555
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5737
  • Fax:
Mailing address:
  • Phone: 402-305-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1376118364
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number75229
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: