Provider Demographics
NPI:1124745377
Name:ERICKSON, LUANNA
Entity type:Individual
Prefix:MRS
First Name:LUANNA
Middle Name:
Last Name:ERICKSON
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 1:545 EAST 400 SOUTH
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3324
Mailing Address - Country:US
Mailing Address - Phone:435-650-6363
Mailing Address - Fax:
Practice Address - Street 1:545 EAST 400 SOUTH
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3324
Practice Address - Country:US
Practice Address - Phone:435-650-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider