Provider Demographics
NPI:1265687529
Name:SEAGRAVE, ERICA LENN (CNIM)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LENN
Last Name:SEAGRAVE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4450
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-4450
Mailing Address - Country:US
Mailing Address - Phone:317-694-1753
Mailing Address - Fax:317-571-1591
Practice Address - Street 1:4851 DEER RIDGE DR S
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8910
Practice Address - Country:US
Practice Address - Phone:317-694-1753
Practice Address - Fax:317-571-1591
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2022-04-14
Deactivation Date:2018-09-26
Deactivation Code:
Reactivation Date:2022-04-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG