Provider Demographics
NPI:1740935840
Name:DAVIS RACKLIFF, ERICA DAWN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN
Last Name:DAVIS RACKLIFF
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 FERN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5504
Mailing Address - Country:US
Mailing Address - Phone:207-538-8833
Mailing Address - Fax:
Practice Address - Street 1:32 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6100
Practice Address - Country:US
Practice Address - Phone:207-538-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME51401163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant