MEDICARE: MRS. JENNIFER ANNE ERICKSON N.P.

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	363LG0600X	Gerontology Nurse Practitioner	SP007259	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500025007	OTHER	PA	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SM1374026	OTHER	PA	PENNSYLVANIA BLUESHIELD
3	07791408	OTHER	PA	PROVIDER TYPE 57 ID NUMBE

General Provider Information

NPI Number	:	1992856413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANNE ERICKSON N.P.

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-926-9022
Fax Number	:	215-226-8286

Provider Business Practice Location Address
First Line	:	7602 CENTRAL AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-969-2900
Fax Number	:	215-969-1856

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	04/03/2017

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Directions to “ MRS. JENNIFER ANNE ERICKSON N.P.” Practice Location

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