1508208927 NPI number — DARLA A ERICKSON DIPL. AC.

Table of content: DARLA A ERICKSON DIPL. AC. (NPI 1508208927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508208927 NPI number — DARLA A ERICKSON DIPL. AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICKSON
Provider First Name:
DARLA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DIPL. AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508208927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9377 WENTLOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55125-3419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-491-5272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 COMMERCE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-491-5272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821430661 . This is a "NPI TYPE 2 ORGANIZATION NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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