Provider Demographics
NPI:1477600203
Name:WAAG, ERICA L (RN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:WAAG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-0565
Mailing Address - Country:US
Mailing Address - Phone:631-306-5874
Mailing Address - Fax:631-306-5884
Practice Address - Street 1:998 CROOKED HILL RD BLDG 5
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-306-5784
Practice Address - Fax:631-306-5884
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY463627-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse