Individual
KELLEY ANNETTE ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(701) 400-4836
Mailing address
2039 SAINT ALBANS ST, PHILADELPHIA, PA 19146-1334
(701) 400-4836
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP016825
PA
Other
Enumeration date
11/17/2016
Last updated
11/17/2016
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