Provider Demographics
NPI:1023240116
Name:ERICKSEN, KATHRYN ELLEN (GNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ELLEN
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 INGRAHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-5513
Mailing Address - Country:US
Mailing Address - Phone:607-621-0313
Mailing Address - Fax:
Practice Address - Street 1:3700 OLD VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2229
Practice Address - Country:US
Practice Address - Phone:607-221-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340744-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology