Provider Demographics
NPI:1417262536
Name:ZERNZACH, ERICA M (LAC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:M
Last Name:ZERNZACH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 S WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1312
Mailing Address - Country:US
Mailing Address - Phone:414-651-2850
Mailing Address - Fax:
Practice Address - Street 1:2252 S WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1312
Practice Address - Country:US
Practice Address - Phone:414-651-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI514-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist