Provider Demographics
NPI:1558653279
Name:ERICKSON, ANDREA S (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:ERICKSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:S
Other - Last Name:HOESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:719 W. HAMILTON AVE.
Mailing Address - Street 2:STE. B
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6970
Mailing Address - Country:US
Mailing Address - Phone:715-552-9784
Mailing Address - Fax:715-835-6370
Practice Address - Street 1:617 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6223
Practice Address - Country:US
Practice Address - Phone:715-834-2788
Practice Address - Fax:715-858-3433
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2753-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00981622OtherRAILROAD MEDICARE
WI1558653279Medicaid
WI000019055Medicare PIN
WIP00981622OtherRAILROAD MEDICARE