Provider Demographics
NPI:1578270658
Name:HALLBACK, ERIKKA BAILEY
Entity Type:Individual
Prefix:
First Name:ERIKKA
Middle Name:BAILEY
Last Name:HALLBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIKKA
Other - Middle Name:NICOLE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 CARBE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2709
Mailing Address - Country:US
Mailing Address - Phone:804-562-7202
Mailing Address - Fax:
Practice Address - Street 1:115 CARBE CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-2709
Practice Address - Country:US
Practice Address - Phone:804-562-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver