Provider Demographics
NPI:1508260548
Name:DANVER, ERIKA DALE RENE'
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:DALE RENE'
Last Name:DANVER
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 1:310 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1374
Mailing Address - Country:US
Mailing Address - Phone:740-710-6065
Mailing Address - Fax:
Practice Address - Street 1:445 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4145
Practice Address - Country:US
Practice Address - Phone:740-703-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0042502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer