Provider Demographics
NPI:1467147140
Name:DYCUS, ERIKA KRISTINE (RN LDN)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:KRISTINE
Last Name:DYCUS
Suffix:
Gender:F
Credentials:RN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7501
Mailing Address - Country:US
Mailing Address - Phone:815-451-9367
Mailing Address - Fax:
Practice Address - Street 1:2387 ACHILLES CT
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3932
Practice Address - Country:US
Practice Address - Phone:815-451-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
IL164009162133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty