Provider Demographics
NPI:1053357426
Name:ERICSON, DANA LYNNE (CNM)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYNNE
Last Name:ERICSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNNE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1248 39TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2605
Mailing Address - Country:US
Mailing Address - Phone:515-279-0382
Mailing Address - Fax:515-279-9619
Practice Address - Street 1:1250 39TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-2605
Practice Address - Country:US
Practice Address - Phone:515-279-3320
Practice Address - Fax:515-279-9619
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB051584367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife