Provider Demographics
NPI:1093436735
Name:NIEWALD, ERIKA DANA (LAC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:DANA
Last Name:NIEWALD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 FARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4539
Mailing Address - Country:US
Mailing Address - Phone:509-290-7724
Mailing Address - Fax:
Practice Address - Street 1:477 COOPER RD STE 320
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-6045
Practice Address - Country:US
Practice Address - Phone:614-423-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000415171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist