Provider Demographics
NPI:1639862816
Name:MEMMER-TAKAHASHI, ERICA (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:MEMMER-TAKAHASHI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:MEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 BUNTIN ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1320
Mailing Address - Country:US
Mailing Address - Phone:812-885-8622
Mailing Address - Fax:812-885-8621
Practice Address - Street 1:121 BUNTIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1320
Practice Address - Country:US
Practice Address - Phone:812-885-8622
Practice Address - Fax:812-885-8621
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program