Carly Mae Johnson Erickson, ND
Individual provider Active NPI Naturopath · Alexandria, MN
NPI 1629486246 · NPPES record last updated Sep 26, 2019
Key facts
- NPI
- 1629486246
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Naturopath 175F00000X
- License
- 1057 (MN)
- Practice address
- 503 Hawthorne St Ste 145
Alexandria, MN 56308-1991 - Phone
- (320) 200-1477
- NPI assigned
- Jul 28, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1057 | MN | MD | Naturopath |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Naturopath | 175F00000X | 1057 | MN | Yes |
Addresses
Primary practice location
503 Hawthorne St Ste 145
Alexandria, MN 56308-1991
Mailing address
1807 Woodland Park Dr NE
Alexandria, MN 56308-8584
Phone (320) 200-1477
Other providers in Alexandria, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.