1457733750 NPI number — MRS. ERIKA NICOLE ISAACS CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457733750 NPI number — MRS. ERIKA NICOLE ISAACS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAACS
Provider First Name:
ERIKA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARMER
Provider Other First Name:
ERIKA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457733750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1735 27TH ST
Provider Second Line Business Mailing Address:
WALLER BUILDING, SUITE B06
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-2677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-356-8681
Provider Business Mailing Address Fax Number:
740-353-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-356-8681
Provider Business Practice Location Address Fax Number:
740-353-7900
Provider Enumeration Date:
06/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  COA. 17269-NA , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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