Provider Demographics
NPI:1730902750
Name:ERICKSON, AMANDA JOY (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:ELSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN; RN
Mailing Address - Street 1:106 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1249
Mailing Address - Country:US
Mailing Address - Phone:701-388-6092
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-232-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse