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General NPI Number Information
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NPI Number | 1710032321
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Entity Type | Individual
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Provider Name | MONICA RAE ERICKSON ATC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1381 JEFFERSON RD
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City | NORTHFIELD
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State | MN
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Zip | 55057-3080
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Country | US
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Telephone | 507-646-7371
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Fax |
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Provider Business Mailing Address
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Address Line | 9370 COUNTY 1 BLVD
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City | CANNON FALLS
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State | MN
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Zip | 55009-5337
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Country | US
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Telephone | 507-263-7299
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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