Provider Demographics
NPI:1871247833
Name:DIFFENDERFER, ERICKS K
Entity Type:Individual
Prefix:
First Name:ERICKS
Middle Name:K
Last Name:DIFFENDERFER
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 1:1453 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-5022
Mailing Address - Country:US
Mailing Address - Phone:304-676-7851
Mailing Address - Fax:304-267-3599
Practice Address - Street 1:1453 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5022
Practice Address - Country:US
Practice Address - Phone:304-676-7851
Practice Address - Fax:304-267-3599
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV99151163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool