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Individual

MRS. JENNIFER ANNE ERICKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
7602 CENTRAL AVE, SUITE 101, PHILADELPHIA, PA 19111-2443
(215) 969-2900
(215) 969-1856
Mailing address
2450 W HUNTING PARK AVE, 2ND FLOOR, PHILADELPHIA, PA 19129-1302
(215) 926-9022
(215) 226-8286

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
SP007259
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
07791408
PROVIDER TYPE 57 ID NUMBE
PA
01
500025007
RAILROAD MEDICARE #
PA
01
SM1374026
PENNSYLVANIA BLUESHIELD
PA
Enumeration date
01/12/2007
Last updated
04/03/2017
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