Provider Demographics
NPI:1548796394
Name:ANDERSON, ERICA (RN-BC, MS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN-BC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16160 E PRENTICE LN
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4169
Mailing Address - Country:US
Mailing Address - Phone:720-606-1370
Mailing Address - Fax:
Practice Address - Street 1:16160 E PRENTICE LN
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4169
Practice Address - Country:US
Practice Address - Phone:720-606-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO183380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse