Provider Demographics
NPI:1073894275
Name:TONKIN, ERICA KAY (LMBT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:KAY
Last Name:TONKIN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-7893
Mailing Address - Country:US
Mailing Address - Phone:304-364-4600
Mailing Address - Fax:
Practice Address - Street 1:531 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-7893
Practice Address - Country:US
Practice Address - Phone:304-364-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2011-2869174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist