Provider Demographics
NPI:1154568376
Name:ERDRICH, BRIAN E (ANP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:ERDRICH
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 DEBARR RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2959
Mailing Address - Country:US
Mailing Address - Phone:907-339-4650
Mailing Address - Fax:907-339-4694
Practice Address - Street 1:2925 DEBARR RD STE 240
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2959
Practice Address - Country:US
Practice Address - Phone:907-339-4650
Practice Address - Fax:907-339-4694
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19840163WC0200X
AK1229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1576654Medicaid
AKK164329Medicare PIN