Provider Demographics
NPI:1700937141
Name:ERICKSON, LISA L (APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 RALEIGH COMMON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2485
Mailing Address - Country:US
Mailing Address - Phone:901-878-3366
Mailing Address - Fax:901-492-4941
Practice Address - Street 1:4913 RALEIGH COMMON DR STE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2485
Practice Address - Country:US
Practice Address - Phone:901-878-3366
Practice Address - Fax:901-492-4941
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6959363LF0000X
TNAPN6959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903204Medicaid
TN4293227OtherBCBS
TN103I500157Medicare PIN
TN4293227OtherBCBS