Provider Demographics
NPI:1386672145
Name:ERICKSON, ANNE (CNM)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MCCREIGHT AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-399-6922
Mailing Address - Fax:
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-399-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM-04227367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2047403Medicaid
OHNM02473Medicare PIN
OH2047403Medicaid