Provider Demographics
NPI:1588018311
Name:ERIKSSON, JOANN H (APN-CNS)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:H
Last Name:ERIKSSON
Suffix:
Gender:F
Credentials:APN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 PFINGSTEN RD
Mailing Address - Street 2:KELLOGG CANCER CENTER
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1339
Mailing Address - Country:US
Mailing Address - Phone:847-503-1000
Mailing Address - Fax:847-503-1100
Practice Address - Street 1:2180 PFINGSTEN RD
Practice Address - Street 2:KELLOGG CANCER CENTER
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-503-1000
Practice Address - Fax:847-503-1100
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001583364S00000X
IL041183712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP52258Medicare UPIN