Provider Demographics
NPI:1033374525
Name:ERICKSON, MILLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MILLIE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MILLIE
Other - Middle Name:
Other - Last Name:PEVZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:611 W. FRANCIS ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101
Mailing Address - Country:US
Mailing Address - Phone:308-568-3500
Mailing Address - Fax:308-568-3509
Practice Address - Street 1:611 W. FRANCIS ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101
Practice Address - Country:US
Practice Address - Phone:308-568-3500
Practice Address - Fax:308-568-3509
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26362208800000X
VA0101243446208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology