Provider Demographics
NPI:1992717623
Name:ERICKSON, CAROL (APRN)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:7 ELM ST
Practice Address - Street 2:SUITE 307
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3626
Practice Address - Country:US
Practice Address - Phone:860-253-7236
Practice Address - Fax:860-253-7243
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000706363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ38290Medicare UPIN