Provider Demographics
NPI:1831696921
Name:AMUNDSON, ERIKA M
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:M
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRAIRIE RIVER HOME CARE
Mailing Address - Street 2:117 W BLUE EARTH AVE
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031
Mailing Address - Country:US
Mailing Address - Phone:507-238-3898
Mailing Address - Fax:
Practice Address - Street 1:117 W BLUE EARTH AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-1724
Practice Address - Country:US
Practice Address - Phone:507-238-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2339397163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health