Healthcare Provider Details

I. General information

NPI: 1134661085
Provider Name (Legal Business Name): ERICKA DEKLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 03/15/2022
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 US ROUTE 5
WESTMINSTER VT
05158-9651
US

IV. Provider business mailing address

4923 US ROUTE 5
WESTMINSTER VT
05158-9651
US

V. Phone/Fax

Practice location:
  • Phone: 802-584-4679
  • Fax:
Mailing address:
  • Phone: 802-722-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0114153
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134967
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: