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General NPI Number Information
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NPI Number | 1538419692
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Entity Type | Individual
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Provider Name | SEAN ERICKSON PMHNP
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Gender | Male
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 5373 S GREEN ST STE 400
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City | MURRAY
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State | UT
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Zip | 84123-4740
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Country | US
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Telephone | 833-442-2670
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60403160
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 5359524-3102
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60399107
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5359524-4405
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License Number State | UT
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