Provider Demographics
NPI:1144206715
Name:ERICKSON, DAVID W (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4122 E TOWNE BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704
Practice Address - Country:US
Practice Address - Phone:608-242-6855
Practice Address - Fax:608-242-6848
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70OtherDEANCARE PROV #
WI43888400Medicaid
WI500010950OtherRAILROAD MEDICARE PROV #
WI1009390OtherPHYS PLUS PROV #
WI391023846OtherCOMM INS PROV #
WI000200130Medicare ID - Type UnspecifiedPART B MEDICARE PROV #
WI500010950OtherRAILROAD MEDICARE PROV #