Basic Information
| Provider Information | |||||||||
| NPI: | 1457467565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | WYNELLE | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766452670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545808500 | ||||||||
| FaxNumber: | 2545822144 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766452670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545808500 | ||||||||
| FaxNumber: | 2545822144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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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 | 367500000X | 516632 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.