Provider Demographics
NPI:1477043735
Name:ERICA MATLUCK, NURSE PRACTITIONER IN FAMILY HEATH, PLLC
Entity Type:Organization
Organization Name:ERICA MATLUCK, NURSE PRACTITIONER IN FAMILY HEATH, PLLC
Other - Org Name:SEVEN SENSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:RAGAN
Authorized Official - Last Name:MATLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:NP, ND
Authorized Official - Phone:415-849-0651
Mailing Address - Street 1:17 JOHN ST # 603
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4010
Mailing Address - Country:US
Mailing Address - Phone:415-849-0651
Mailing Address - Fax:628-895-9500
Practice Address - Street 1:17 JOHN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:415-849-0651
Practice Address - Fax:628-895-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-12
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND480261Q00000X
NYRN668584261Q00000X
NYNP-337922261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center