Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 322 | NE |
NPI | 1013152396 |
---|---|
Provider Name | Dr. Alicia M Ericksen |
First Address | Ainsworth, NE 69210-1556 |
Second Address | Ainsworth, NE 69210-1556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 07/07/2015 |