Provider Demographics
NPI:1134355209
Name:MIKKELSEN, ERIK R (CRNA)
Entity type:Individual
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First Name:ERIK
Middle Name:R
Last Name:MIKKELSEN
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:PSSB SUITE 1200 DEPT OF ANESTHESIOLOGY AND PAIN MED
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-5028
Mailing Address - Fax:916-734-2975
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB SUITE 1200 DEPT OF ANESTHESIOLOGY AND PAIN MED
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5028
Practice Address - Fax:916-734-2975
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2015-10-12
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Provider Licenses
StateLicense IDTaxonomies
CA95000103367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered