Provider Demographics
NPI:1871558858
Name:ERICKSON, KATHRYN D (ARNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 JOHN DEERE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6892
Mailing Address - Country:US
Mailing Address - Phone:309-779-4600
Mailing Address - Fax:309-779-4605
Practice Address - Street 1:500 JOHN DEERE RD STE 400
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6892
Practice Address - Country:US
Practice Address - Phone:309-779-4600
Practice Address - Fax:309-779-4605
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003743363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83193Medicare UPIN