Basic Information
| Provider Information | |||||||||
| NPI: | 1205303229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAEDRICH | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44172 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | MCARTHUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960568560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307170324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43563 HWY 299 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER MILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303366535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2018 | ||||||||
| LastUpdateDate: | 10/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 56202 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.