Provider Demographics
NPI:1265687529
Name:SEAGRAVE, ERICA LENN (CNIM)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LENN
Last Name:SEAGRAVE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17025 E LA MONTANA DR UNIT 132
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8583
Mailing Address - Country:US
Mailing Address - Phone:317-503-1350
Mailing Address - Fax:
Practice Address - Street 1:2500 DALLAS PKWY STE 500
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4805
Practice Address - Country:US
Practice Address - Phone:317-503-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2025-01-23
Deactivation Date:2018-09-26
Deactivation Code:
Reactivation Date:2022-04-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG