Provider Demographics
NPI:1407264229
Name:WAVER, ERIKA BROOKE (FNP)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:BROOKE
Last Name:WAVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:BROOKE
Other - Last Name:HARLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:14140-0112
Mailing Address - Country:US
Mailing Address - Phone:585-969-8311
Mailing Address - Fax:
Practice Address - Street 1:139 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5369
Practice Address - Country:US
Practice Address - Phone:716-433-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily