Provider Demographics
NPI:1093426900
Name:SHOCK, ERIKA TATUM
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:TATUM
Last Name:SHOCK
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 1:1190 CINNAMON HILL LN APT 308
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8180
Mailing Address - Country:US
Mailing Address - Phone:573-281-5611
Mailing Address - Fax:
Practice Address - Street 1:1190 CINNAMON HILL LN APT 308
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8180
Practice Address - Country:US
Practice Address - Phone:573-281-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program