Provider Demographics
NPI:1255504122
Name:HARE, ERICA DENISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DENISE
Last Name:HARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DENISE
Other - Last Name:WAITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1700 FOUNTAIN CT
Mailing Address - Street 2:APT# 405
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1606
Mailing Address - Country:US
Mailing Address - Phone:706-341-2811
Mailing Address - Fax:
Practice Address - Street 1:7950 MARTIN LOOP
Practice Address - Street 2:BLDG 9200
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5647
Practice Address - Country:US
Practice Address - Phone:706-544-2048
Practice Address - Fax:706-544-1388
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-051161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse