Provider Demographics
NPI:1699390872
Name:CORRADINO, ERICA L
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:CORRADINO
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 1:5736 CARNATION AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1570
Mailing Address - Country:US
Mailing Address - Phone:219-628-1281
Mailing Address - Fax:
Practice Address - Street 1:710 FRANKLIN ST STE 200
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3564
Practice Address - Country:US
Practice Address - Phone:219-872-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010094A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily