Provider Demographics
NPI:1649592627
Name:ANDERSON, ERICA (LM)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 JESSIE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1527
Mailing Address - Country:US
Mailing Address - Phone:830-201-2413
Mailing Address - Fax:737-828-1069
Practice Address - Street 1:13702 COPPER HILLS DR
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3136
Practice Address - Country:US
Practice Address - Phone:512-470-3749
Practice Address - Fax:512-906-0105
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X, 374J00000X
TX99272176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula