Provider Demographics
NPI:1790193068
Name:ERICKSON, ANNE-MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 W 44TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2761
Mailing Address - Country:US
Mailing Address - Phone:303-831-6686
Mailing Address - Fax:
Practice Address - Street 1:10900 W 44TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2761
Practice Address - Country:US
Practice Address - Phone:303-831-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant