Provider Demographics
NPI:1033471701
Name:DOUGLAS, ERICA SARKIESHAN (MSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SARKIESHAN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 FERGUSON AVE
Mailing Address - Street 2:NONE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2518
Mailing Address - Country:US
Mailing Address - Phone:314-517-1613
Mailing Address - Fax:314-727-1230
Practice Address - Street 1:1063 FERGUSON AVE
Practice Address - Street 2:NONE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2518
Practice Address - Country:US
Practice Address - Phone:314-517-1613
Practice Address - Fax:314-727-1230
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide