Provider Demographics
NPI:1639305766
Name:ERICKSON, KRISTIN J (RN, BSN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:J
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W FIR AVE
Mailing Address - Street 2:GOVERNMENT SERVICES CENTER
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1364
Mailing Address - Country:US
Mailing Address - Phone:218-998-8336
Mailing Address - Fax:218-998-8352
Practice Address - Street 1:560 W FIR AVE
Practice Address - Street 2:GOVERNMENT SERVICES CENTER
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1364
Practice Address - Country:US
Practice Address - Phone:218-998-8336
Practice Address - Fax:218-998-8352
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN181599-3163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health