Provider Demographics
NPI:1811325996
Name:WHITAKER, ERICA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1322 RAGLAND GULLY
Mailing Address - Street 2:
Mailing Address - City:BRENT
Mailing Address - State:AL
Mailing Address - Zip Code:35034-2949
Mailing Address - Country:US
Mailing Address - Phone:205-292-9021
Mailing Address - Fax:
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-554-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-062566164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2-062566OtherSTATE