MEDICARE: ERIKA MARIE PERCIC CRNA

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	RN113116	AZ
2	367500000X	Certified Registered Nurse Anesthetist	APN.0991990-CRNA	CO
3	367500000X	Certified Registered Nurse Anesthetist	CRNA0544	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00625197	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265624456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA MARIE PERCIC CRNA

Provider Business Mailing Address
First Line	:	13400 E SHEA BLVD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-5452
Country	:	US
Telephone Number	:	480-301-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 N 44TH ST STE L200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1675
Country	:	US
Telephone Number	:	602-343-2900
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	09/30/2021

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Directions to “ ERIKA MARIE PERCIC CRNA” Practice Location

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