Provider Demographics
NPI:1366887796
Name:ERICKSON, MOLLY KATE (BSN RN MSN ANP-BC)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:KATE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:BSN RN MSN ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 W HARRISON ST
Mailing Address - Street 2:SUITE 913 JELKE BUILDING
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3825
Mailing Address - Country:US
Mailing Address - Phone:312-563-3700
Mailing Address - Fax:312-563-3701
Practice Address - Street 1:1750 W HARRISON ST
Practice Address - Street 2:SUITE 913 JELKE BUILDING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3825
Practice Address - Country:US
Practice Address - Phone:312-563-3700
Practice Address - Fax:312-563-3701
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010240363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health