Provider Demographics
NPI:1841824547
Name:HARRIS, ERICA BROOKE
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:BROOKE
Last Name:HARRIS
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 1:2526 REVERE AVE
Mailing Address - Street 2:APT 10
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420
Mailing Address - Country:US
Mailing Address - Phone:708-580-9158
Mailing Address - Fax:
Practice Address - Street 1:2526 REVERE AVE
Practice Address - Street 2:APT 10
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420
Practice Address - Country:US
Practice Address - Phone:708-580-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0362648Medicaid