MEDICARE: MS. TRACY J ERICKSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse		WI

General Provider Information

NPI Number	:	1144494758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY J ERICKSON RN

Provider Business Mailing Address
First Line	:	445 N GLENDALE AVE
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-1310
Country	:	US
Telephone Number	:	608-387-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 N GLENDALE AVE
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-1310
Country	:	US
Telephone Number	:	608-387-0773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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