Provider Demographics
NPI:1871029009
Name:SMITH, ERIKA DIONNE
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:DIONNE
Last Name:SMITH
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 1:8455 S EGGLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-1064
Mailing Address - Country:US
Mailing Address - Phone:312-331-0842
Mailing Address - Fax:
Practice Address - Street 1:8455 S EGGLESTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1064
Practice Address - Country:US
Practice Address - Phone:312-331-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJ16220470735172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver