Provider Demographics
NPI:1164007993
Name:MOORE, ERICKA L (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 ZANDER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9019
Mailing Address - Country:US
Mailing Address - Phone:707-416-7766
Mailing Address - Fax:
Practice Address - Street 1:3031 ZANDER DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-9019
Practice Address - Country:US
Practice Address - Phone:707-416-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator