Provider Demographics
NPI:1669551495
Name:ERICKSON, LAUREL L (MD)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110105 PIONEER TRL W
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2680
Mailing Address - Country:US
Mailing Address - Phone:952-556-0120
Mailing Address - Fax:952-556-0121
Practice Address - Street 1:110105 PIONEER TRL W
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318
Practice Address - Country:US
Practice Address - Phone:952-556-0120
Practice Address - Fax:952-556-0121
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics