Provider Demographics
NPI:1164618625
Name:ROBERTS, ERICA BAILEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:BAILEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9002
Mailing Address - Country:US
Mailing Address - Phone:585-388-3359
Mailing Address - Fax:
Practice Address - Street 1:4276 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9002
Practice Address - Country:US
Practice Address - Phone:585-388-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02335615163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335615Medicaid