Provider Demographics
NPI:1972807436
Name:ERICKSON, JULIE (CRNA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3542
Mailing Address - Country:US
Mailing Address - Phone:603-752-2200
Mailing Address - Fax:603-326-5831
Practice Address - Street 1:59 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570
Practice Address - Country:US
Practice Address - Phone:603-752-2200
Practice Address - Fax:603-326-5831
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-126831367500000X
NH606093-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered