Provider Demographics
NPI:1346252053
Name:ERICKSON, CLAUDE (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WEST 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MN
Mailing Address - Zip Code:55705
Mailing Address - Country:US
Mailing Address - Phone:218-229-3311
Mailing Address - Fax:
Practice Address - Street 1:405 WEST 3RD AVE N
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705
Practice Address - Country:US
Practice Address - Phone:218-229-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN341267900Medicaid
MN970003444Medicare PIN