Individual
KELLY MARIE ERICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
403 3RD ST, YUTAN, NE 68073-3143
(402) 957-0703
Mailing address
9815 MADISON PLZ APT 10, OMAHA, NE 68127-3262
(402) 957-0703
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05207735-NE
—
NE
Enumeration date
12/31/2024
Last updated
12/31/2024
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