Provider Demographics
NPI:1316582224
Name:ERICKSON, SERRYN
Entity Type:Individual
Prefix:
First Name:SERRYN
Middle Name:
Last Name:ERICKSON
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 1:1502 9TH ST E
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-3430
Mailing Address - Country:US
Mailing Address - Phone:715-235-7373
Mailing Address - Fax:715-233-3565
Practice Address - Street 1:1502 9TH ST E
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3430
Practice Address - Country:US
Practice Address - Phone:715-235-7373
Practice Address - Fax:715-233-3565
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider