Provider Demographics
NPI:1710103551
Name:ERUCHALU, COMFORT C (RN)
Entity Type:Individual
Prefix:MS
First Name:COMFORT
Middle Name:C
Last Name:ERUCHALU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 FRAWLEY DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-8904
Mailing Address - Country:US
Mailing Address - Phone:608-217-7928
Mailing Address - Fax:
Practice Address - Street 1:1835 BJOIN DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3141
Practice Address - Country:US
Practice Address - Phone:608-873-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35024000Medicaid