Provider Demographics
NPI:1568085165
Name:WHITEBREAD, ERICA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:WHITEBREAD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ANN
Other - Last Name:VELIKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2232 RED FOX DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-7093
Mailing Address - Country:US
Mailing Address - Phone:570-665-8226
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-248-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN653623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered