Provider Demographics
NPI:1710630942
Name:EISERER, ERICKA JO (NP)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:JO
Last Name:EISERER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:JO
Other - Last Name:BREIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4651 NW TUSCAN RDG
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-3301
Mailing Address - Country:US
Mailing Address - Phone:816-585-7263
Mailing Address - Fax:
Practice Address - Street 1:4651 NW TUSCAN RDG
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-3301
Practice Address - Country:US
Practice Address - Phone:816-585-7263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF12210484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily