Provider Demographics
NPI:1649752205
Name:BALLOU, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BALLOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 W OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3021
Mailing Address - Country:US
Mailing Address - Phone:804-972-4869
Mailing Address - Fax:
Practice Address - Street 1:1069 W OAK HILL DR
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558-3021
Practice Address - Country:US
Practice Address - Phone:804-972-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT62214528343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)