Provider Demographics
NPI:1457467565
Name:ERICKSON, WYNELLE RAE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:WYNELLE
Middle Name:RAE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-2670
Mailing Address - Country:US
Mailing Address - Phone:254-580-8500
Mailing Address - Fax:254-582-2144
Practice Address - Street 1:101 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2670
Practice Address - Country:US
Practice Address - Phone:254-580-8500
Practice Address - Fax:254-582-2144
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516632367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered