Provider Demographics
NPI:1891092391
Name:SNIPES, ERICA L (IDMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:SNIPES
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 AMDS / SGPFP
Mailing Address - Street 2:UNIT 5267
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368-5267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 AMDS / SGPFP
Practice Address - Street 2:UNIT 5267
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5267
Practice Address - Country:US
Practice Address - Phone:0118198-960-4229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians