Provider Demographics
NPI:1619487089
Name:BOTELHO, ERICA L (ANP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:BOTELHO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MILLIKEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1604
Mailing Address - Country:US
Mailing Address - Phone:508-674-5200
Mailing Address - Fax:508-674-5211
Practice Address - Street 1:211 MILLIKEN BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1604
Practice Address - Country:US
Practice Address - Phone:508-674-5200
Practice Address - Fax:508-674-5211
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260799363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health