Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2010-01059 | NC |
Y | 208600000X | Surgeon | 2010-01059 | NC |
N | 2086S0120X | Pediatric Surgery | 2010-01059 | NC |
NPI | 1649289679 |
---|---|
Provider Name | Kimberly Mccrudden Erickson |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610-1247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 23/02/2021 |