Provider Demographics
NPI:1003689050
Name:HALLER, ERICA LYNN (RPSGT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:HALLER
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45335-1559
Mailing Address - Country:US
Mailing Address - Phone:937-474-4233
Mailing Address - Fax:
Practice Address - Street 1:16 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:OH
Practice Address - Zip Code:45335-1559
Practice Address - Country:US
Practice Address - Phone:937-474-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant