Provider Demographics
NPI:1295442390
Name:BROWN, ERICKA DANIELLE
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:DANIELLE
Last Name:BROWN
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 1:12785 CHICKEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:SHOALS
Mailing Address - State:IN
Mailing Address - Zip Code:47581-7179
Mailing Address - Country:US
Mailing Address - Phone:812-709-0595
Mailing Address - Fax:
Practice Address - Street 1:155 E BURKS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8459
Practice Address - Country:US
Practice Address - Phone:812-332-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28198126363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health