Provider Demographics
NPI:1972254860
Name:ANDERSON, ERIQUAH
Entity Type:Individual
Prefix:
First Name:ERIQUAH
Middle Name:
Last Name:ANDERSON
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 1:561 CORKHILL RD APT 234
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3471
Mailing Address - Country:US
Mailing Address - Phone:216-553-9859
Mailing Address - Fax:
Practice Address - Street 1:561 CORKHILL RD APT 234
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3471
Practice Address - Country:US
Practice Address - Phone:216-553-9859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant