Provider Demographics
NPI:1013152396
Name:ERICKSEN, ALICIA M
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:M
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:BESHALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 E ZERO ST
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1556
Mailing Address - Country:US
Mailing Address - Phone:402-387-2067
Mailing Address - Fax:402-387-0298
Practice Address - Street 1:945 E ZERO ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1556
Practice Address - Country:US
Practice Address - Phone:402-387-2067
Practice Address - Fax:402-387-0298
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE322213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery