Provider Demographics
NPI:1649586678
Name:LUNSFORD, ERICA JANAE (STUDENT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JANAE
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29602 MIDNIGHT SUN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015
Mailing Address - Country:US
Mailing Address - Phone:210-274-9294
Mailing Address - Fax:
Practice Address - Street 1:29602 MIDNIGHT SUN
Practice Address - Street 2:
Practice Address - City:FAIR OAKS RANCH
Practice Address - State:TX
Practice Address - Zip Code:78015
Practice Address - Country:US
Practice Address - Phone:210-274-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant