Provider Demographics
NPI:1831370469
Name:DAMEWOOD, ERICA LYNN (CRNA)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LYNN
Last Name:DAMEWOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:WV
Mailing Address - Zip Code:24712-0225
Mailing Address - Country:US
Mailing Address - Phone:304-952-8515
Mailing Address - Fax:
Practice Address - Street 1:454 MCDOWELL ST
Practice Address - Street 2:TEAM HEALTH/WELCH COMMUNITY HOSPITAL
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2029
Practice Address - Country:US
Practice Address - Phone:304-436-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48953367500000X
WVAPRN48953-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered