Provider Demographics
NPI:1629204342
Name:ERICKSON, GINA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:SHOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 DUFF AVENUE PO BOX 3014
Mailing Address - Street 2:MCFARLAND CLINIC PC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-2155
Mailing Address - Fax:515-239-2155
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:MCFARLAND CLINIC PC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5745
Practice Address - Country:US
Practice Address - Phone:515-239-2155
Practice Address - Fax:515-239-2155
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00831207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919120Medicaid
NC5919120Medicaid