Provider Demographics
NPI:1881863736
Name:BROWN, ERICA L
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNMW
Mailing Address - Street 1:15 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1841
Mailing Address - Country:US
Mailing Address - Phone:220-564-4672
Mailing Address - Fax:220-564-1970
Practice Address - Street 1:15 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1841
Practice Address - Country:US
Practice Address - Phone:220-564-4672
Practice Address - Fax:220-564-1970
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNM09774367A00000X
OHCOA.09774.NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2829854Medicaid
OH2829854Medicaid