Basic Information
| Provider Information | |||||||||
| NPI: | 1295764975 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WICKS | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805388702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA.0001957 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA.0001957 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 68321848 | 05 | CO | MEDICAID |