Provider Demographics
NPI:1679867469
Name:KRELLER, ERICA JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:JOAN
Last Name:KRELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2621
Mailing Address - Country:US
Mailing Address - Phone:402-390-6600
Mailing Address - Fax:402-390-9851
Practice Address - Street 1:6901 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2621
Practice Address - Country:US
Practice Address - Phone:402-390-6600
Practice Address - Fax:402-390-9851
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124132207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN