Provider Demographics
NPI:1700215829
Name:ERICKSEN-CLARKE, DAWN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ERICKSEN-CLARKE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19213 AMBER WAY
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-8349
Practice Address - Country:US
Practice Address - Phone:317-797-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004710A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01456970OtherMEDICARE RR
IN28175006AOtherRN LICENSE
IN201229190Medicaid
IN71004710AOtherAPN PRESCRIPTIVE AUTHORITY
IN266180478Medicare PIN