Provider Demographics
NPI:1720710395
Name:ERICKSON, ELIZABETH CHRISTINE (DNP FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:DNP FNP
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:4732 MOUNTAIN PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1703
Mailing Address - Country:US
Mailing Address - Phone:208-705-4630
Mailing Address - Fax:
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-239-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP73348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily