Provider Demographics
NPI:1518602622
Name:ERICKSON, AMANDA LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLARA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56222-1403
Mailing Address - Country:US
Mailing Address - Phone:320-905-0921
Mailing Address - Fax:
Practice Address - Street 1:525 MAIN ST W
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1043
Practice Address - Country:US
Practice Address - Phone:320-256-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily