Healthcare Provider Details

I. General information

NPI: 1568756393
Provider Name (Legal Business Name): NICOLE ERKELENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5444 GREEN ST
MURRAY UT
84123-5632
US

IV. Provider business mailing address

5444 GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-284-1702
  • Fax: 801-262-3897
Mailing address:
  • Phone: 801-284-1702
  • Fax: 801-262-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5994436-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: