Provider Demographics
NPI:1992798573
Name:ERICKSON, DIXIE D (ANP)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:D
Last Name:ERICKSON
Suffix:
Gender:F
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:PO BOX 202113
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-2113
Mailing Address - Country:US
Mailing Address - Phone:907-929-8704
Mailing Address - Fax:907-929-8744
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 216
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-563-2873
Practice Address - Fax:907-563-5852
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP91071Medicaid
AK0178870OtherWA DEPT OF L&I
AK0178870OtherWA DEPT OF L&I
AK153193Medicare ID - Type UnspecifiedNORIDIAN MEDICARE