Provider Demographics
NPI:1083466817
Name:WESLEY, ERICA CRYSTAL
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:CRYSTAL
Last Name:WESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2121
Mailing Address - Country:US
Mailing Address - Phone:810-247-4167
Mailing Address - Fax:
Practice Address - Street 1:3436 STONEGATE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2121
Practice Address - Country:US
Practice Address - Phone:810-247-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion