Provider Demographics
NPI:1922708536
Name:ERICKSON, JOSEPHINE CLAIR (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:CLAIR
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOSEPHENE
Other - Middle Name:CLAIR
Other - Last Name:MAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-0963
Mailing Address - Country:US
Mailing Address - Phone:701-872-6116
Mailing Address - Fax:
Practice Address - Street 1:400 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2745
Practice Address - Country:US
Practice Address - Phone:719-584-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0100434-C-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered