Provider Demographics
NPI:1932516069
Name:WHITE, ERIKA ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ALEXANDRIA
Last Name:WHITE
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 1:38 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3710
Mailing Address - Country:US
Mailing Address - Phone:631-560-1137
Mailing Address - Fax:
Practice Address - Street 1:38 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3710
Practice Address - Country:US
Practice Address - Phone:631-560-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301774-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse