Provider Demographics
NPI:1710306196
Name:DERCKS, ERIN LYNN (APNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LYNN
Last Name:DERCKS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:LYNN
Other - Last Name:VERBRUGGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:N3501 TWELVE CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9747
Mailing Address - Country:US
Mailing Address - Phone:920-740-2277
Mailing Address - Fax:
Practice Address - Street 1:820 W ASSOCIATION DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1495
Practice Address - Country:US
Practice Address - Phone:920-380-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5741-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health