Provider Demographics
NPI:1528376142
Name:WALTERS, ERICA LYNN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LYNN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 FATTLER RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:OH
Mailing Address - Zip Code:43771-9771
Mailing Address - Country:US
Mailing Address - Phone:740-303-3067
Mailing Address - Fax:
Practice Address - Street 1:1925 FATTLER RIDGE RD
Practice Address - Street 2:
Practice Address - City:PHILO
Practice Address - State:OH
Practice Address - Zip Code:43771-9603
Practice Address - Country:US
Practice Address - Phone:740-303-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 141188164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse