Provider Demographics
NPI:1417561697
Name:POLAND, ERIKA ADEL (LPN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ADEL
Last Name:POLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ADEL
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4048 GLENBURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-2535
Mailing Address - Country:US
Mailing Address - Phone:517-993-7214
Mailing Address - Fax:
Practice Address - Street 1:2025 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0828
Practice Address - Country:US
Practice Address - Phone:517-371-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703097291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINAOtherPRACTICAL NURSING LICENSE