Individual
IVY L ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
191 THEATER RD, ONALASKA, WI 54650
(608) 785-0940
Mailing address
PO BOX 860912, PROVIDER ENROLLMENT - RST, MINNEAPOLIS, MN 55486-0912
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002336
IA
363A00000X
Physician Assistant
Primary
2923-23
WI
Other
Enumeration date
08/28/2012
Last updated
01/23/2025
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