Basic Information
Provider Information | |||||||||
NPI: | 1457733750 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ISAACS | ||||||||
FirstName: | ERIKA | ||||||||
MiddleName: | NICOLE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FARMER | ||||||||
OtherFirstName: | ERIKA | ||||||||
OtherMiddleName: | NICOLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1735 27TH ST | ||||||||
Address2: | WALLER BUILDING, SUITE B06 | ||||||||
City: | PORTSMOUTH | ||||||||
State: | OH | ||||||||
PostalCode: | 456622677 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7403568681 | ||||||||
FaxNumber: | 7403537900 | ||||||||
Practice Location | |||||||||
Address1: | 1805 27TH ST | ||||||||
Address2: |   | ||||||||
City: | PORTSMOUTH | ||||||||
State: | OH | ||||||||
PostalCode: | 456622640 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7403568681 | ||||||||
FaxNumber: | 7403537900 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2015 | ||||||||
LastUpdateDate: | 06/23/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | COA. 17269-NA | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.