Provider Demographics
NPI:1730348327
Name:ERICKSON, JANET LEIGH (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LEIGH
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 13TH AVE EAST
Mailing Address - Street 2:FORT PECK TRIBES HPDP
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255
Mailing Address - Country:US
Mailing Address - Phone:406-768-3052
Mailing Address - Fax:406-768-3383
Practice Address - Street 1:417 13TH AVE EAST
Practice Address - Street 2:FORT PECK TRIBES HPDP
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-3052
Practice Address - Fax:406-768-3383
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-30260363LP0808X
MT30260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT30260OtherRN LICENSE
MT2210068Medicaid