Provider Demographics
NPI:1386929586
Name:ERICKSON, KARISSA HELENE (LPN)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:HELENE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 WAGER RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-4151
Mailing Address - Country:US
Mailing Address - Phone:814-746-0416
Mailing Address - Fax:
Practice Address - Street 1:2315 WAGER RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-4151
Practice Address - Country:US
Practice Address - Phone:814-746-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN284639164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse