Provider Demographics
NPI:1407556434
Name:WITHERSPOON, ERIKA CAMILLE Y
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:CAMILLE Y
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 QUILLEN CIR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1505
Mailing Address - Country:US
Mailing Address - Phone:301-520-9365
Mailing Address - Fax:
Practice Address - Street 1:1140 N CAPITOL ST NW APT 717
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7566
Practice Address - Country:US
Practice Address - Phone:202-313-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant