Basic Information
| Provider Information | |||||||||
| NPI: | 1760079420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | CHRYSTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 MARKETPLACE PLZ | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804871838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708796663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4401 COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829013507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074483220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2020 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.