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Individual

MRS. CHERYL LYNN ERICKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
4813 NEW HAVEN AVE, FORT WAYNE, IN 46803-3018
(260) 449-7504
Mailing address
1310 SHOREVIEW DR, FORT WAYNE, IN 46819-1369

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000493A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000284072
ANTHEM
IN
05
200209490
IN
01
500020243
RAILROAD MEDICARE
IN
Enumeration date
10/10/2005
Last updated
02/28/2012
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