Provider Demographics
NPI:1083845556
Name:ERICKSON, ROSANNA O (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:O
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22801 ACACIA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4142
Mailing Address - Country:US
Mailing Address - Phone:661-296-6366
Mailing Address - Fax:
Practice Address - Street 1:22801 ACACIA CT
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-4142
Practice Address - Country:US
Practice Address - Phone:661-296-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN347129NP4744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner