Provider Demographics
NPI:1174674527
Name:ERICKSON, SUZANNE KAY (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:KAY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9189
Mailing Address - Country:US
Mailing Address - Phone:559-787-2663
Mailing Address - Fax:
Practice Address - Street 1:5044 N BARTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA257580OtherRN LICENSE
CA8839OtherNP CERTIFICATE
CA8839OtherNP CERTIFICATE
CAP79974Medicare UPIN