Provider Demographics
NPI:1871195909
Name:ERICKSON, KARISSA SELENE
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:SELENE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4074
Mailing Address - Country:US
Mailing Address - Phone:567-204-0353
Mailing Address - Fax:
Practice Address - Street 1:1536 CRAYTON AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3722
Practice Address - Country:US
Practice Address - Phone:567-204-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide