Healthcare Provider Details

I. General information

NPI: 1679493548
Provider Name (Legal Business Name): ELLA HAUCK ERICKSON DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 HARRISON DR # 1
EVANSTON WY
82930-3241
US

IV. Provider business mailing address

1224 E JACKSON AVE
RIVERTON WY
82501-3841
US

V. Phone/Fax

Practice location:
  • Phone: 307-288-0404
  • Fax:
Mailing address:
  • Phone: 307-856-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55509
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: