Provider Demographics
NPI:1841044765
Name:BOURGEOIS, ERYKA
Entity type:Individual
Prefix:
First Name:ERYKA
Middle Name:
Last Name:BOURGEOIS
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 1:2608 SEA SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6077
Mailing Address - Country:US
Mailing Address - Phone:504-217-0221
Mailing Address - Fax:
Practice Address - Street 1:2608 SEA SHORE DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-6077
Practice Address - Country:US
Practice Address - Phone:504-217-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor