Provider Demographics
NPI:1619364304
Name:RIDDLE, ERICKA (ATC, LAT, EMT-B)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:ATC, LAT, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 MATTHEWS MINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7594
Mailing Address - Country:US
Mailing Address - Phone:910-297-1357
Mailing Address - Fax:
Practice Address - Street 1:7334 MATTHEWS MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7594
Practice Address - Country:US
Practice Address - Phone:910-297-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP067775146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic