Provider Demographics
NPI:1073144705
Name:ERICKSEN, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 W MAIN ST APT 3
Practice Address - Street 2:
Practice Address - City:LEWIS
Practice Address - State:IA
Practice Address - Zip Code:51544-5528
Practice Address - Country:US
Practice Address - Phone:712-789-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide