Individual
EVELYN J ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3701 12TH ST N, SUITE 100, ST CLOUD, MN 56303
(320) 253-7257
(320) 251-2938
Mailing address
3701 12TH ST N, SUITE 100, ST CLOUD, MN 56303
(320) 253-7257
(320) 251-2938
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
37346
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006655
P-ONE
—
01
—
111011
UCARE
—
01
—
1301024
MEDICA
—
01
—
145719500
NEW MA PROVIDER
—
05
—
145719500
—
MN
01
—
249000019
METRAHEALTH (MPIN)
—
01
—
6T195ER
BCBS
—
Enumeration date
07/18/2006
Last updated
11/29/2010
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