Provider Demographics
NPI:1750868485
Name:ERICKSON, GRETCHEN ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 S ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069-6505
Mailing Address - Country:US
Mailing Address - Phone:320-358-0987
Mailing Address - Fax:320-358-3422
Practice Address - Street 1:460 S ELIOT AVE
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069-6505
Practice Address - Country:US
Practice Address - Phone:320-358-0987
Practice Address - Fax:320-358-3422
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN226100-9163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN226100-9OtherREGISTERED NURSE-CASE MANAGER