Provider Demographics
NPI:1679144372
Name:FICKES, ERICA (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FICKES
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 W ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-5392
Mailing Address - Country:US
Mailing Address - Phone:717-919-8888
Mailing Address - Fax:
Practice Address - Street 1:5550 FRANKLIN PIKE STE 201
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2129
Practice Address - Country:US
Practice Address - Phone:618-855-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN659953163W00000X, 367500000X
IL209.028392367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN659953OtherPA RN LICENSE
IL209.028392OtherIL APRN LICENSE