Provider Demographics
NPI:1083852172
Name:PAGE, ERICKA GABRIELLE (MA, CPC)
Entity Type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:GABRIELLE
Last Name:PAGE
Suffix:
Gender:F
Credentials:MA, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1412
Mailing Address - Country:US
Mailing Address - Phone:313-554-3111
Mailing Address - Fax:
Practice Address - Street 1:412 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1412
Practice Address - Country:US
Practice Address - Phone:313-554-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821292172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker