| Nicole Ericksen, NP | |
|
5171 S Cottonwood St Ste 740, Salt Lake City, UT 84107-5705 | |
| (801) 507-9700 | |
| Not Available |
| Full Name | Nicole Ericksen |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 5171 S Cottonwood St Ste 740, Salt Lake City, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972987568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 8412717-4405 (Utah) | Primary |
| Entity Name | Makana North Shore Clinic |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1114431632 PECOS PAC ID: 8426308883 Enrollment ID: O20180905001897 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Ericksen, NP Po Box 30180, Salt Lake City, UT 84130-0180 Ph: (801) 647-7556 | Nicole Ericksen, NP 5171 S Cottonwood St Ste 740, Salt Lake City, UT 84107-5705 Ph: (801) 507-9700 |
Mrs. Lisa Ann Runyon, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Medical Dr, Trauma Services, Salt Lake City, UT 84113 Phone: 801-662-2993 Fax: 801-662-2999 | |
Madeline Ann Thayer, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 100 N Mario Capecchi Dr, Salt Lake City, UT 84113 Phone: 801-662-3600 | |
Emma Fong, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3802 S 700 E, Salt Lake City, UT 84106 Phone: 801-264-6000 | |
Ashlee Brynn Fenton, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1160 E 3900 S Ste G200, Salt Lake City, UT 84124 Phone: 801-268-7766 | |
Donna M. Wahoff-stice, APRN, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 615 Arapeen Dr, 100, Salt Lake City, UT 84108 Phone: 801-581-7761 | |
Linda M Lambert, A.P.R.N. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Medical Dr, Salt Lake City, UT 84113 Phone: 801-662-1000 | |
Ms. Ann A. K. Kamp, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 N Medical Dr, Salt Lake City, UT 84113 Phone: 801-662-1000 Fax: 801-662-4166 |