Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 013844 | ME |
NPI | 1063488518 |
---|---|
Provider Name | Nicholette Erickson |
First Address | Lewiston, ME 04240-7689 |
Second Address | Lewiston, ME 04240-7689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 15/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F52148 | (02) | ME |