Provider Demographics
NPI:1932812476
Name:BURDETT, ERICA LATRICE (LVN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LATRICE
Last Name:BURDETT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 CEDAR AVE APT D
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4841
Mailing Address - Country:US
Mailing Address - Phone:626-342-2264
Mailing Address - Fax:
Practice Address - Street 1:3340 CEDAR AVE APT D
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4841
Practice Address - Country:US
Practice Address - Phone:626-342-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN220716164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse