Provider Demographics
NPI:1932769148
Name:ERICKSON, JOY LYNN
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:LYNN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:LYNN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 S FIRST ST LOT # 2
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3393
Mailing Address - Country:US
Mailing Address - Phone:307-349-5302
Mailing Address - Fax:
Practice Address - Street 1:390 S FIRST ST LOT # 2
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3393
Practice Address - Country:US
Practice Address - Phone:307-349-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health