Provider Demographics
NPI:1114317922
Name:REDDICK, ERIC DELVAUGHN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DELVAUGHN
Last Name:REDDICK
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 JAYCOX RD APT 106
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1624
Mailing Address - Country:US
Mailing Address - Phone:440-530-0928
Mailing Address - Fax:
Practice Address - Street 1:4365 E 156TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2910
Practice Address - Country:US
Practice Address - Phone:216-203-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH460768163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse